A Nursing Protocol for Risk-Guided Follow-Up After Endoscopic Submucosal Dissection in Early Gastrointestinal Cancer

Endoscopic submucosal dissection (ESD) is widely used for early gastrointestinal cancer, although postoperative recurrence remains clinically relevant. We conducted a two-stage retrospective cohort study. The model-development cohort included 124 patients treated between January 2022 and January 2023, of whom 22 experienced recurrence. Seven nursing-relevant postoperative indicators were entered into a multivariable logistic regression model. Because several indicators were recorded during postoperative follow-up, the model was interpreted as an exploratory recurrence-risk model rather than a baseline prognostic tool. The apparent area under the receiver operating characteristic curve was 0.922 (95% CI, 0.872-0.972); at a probability threshold of 0.1484, sensitivity was 95.45%, and specificity was 84.31%, while bootstrap internal validation yielded an optimism-corrected AUC of 0.884. A separate retrospective comparative cohort included 84 patients treated in 2024: 42 had received model-informed risk-guided follow-up, and 42 had received routine fixed-interval follow-up. During 12 months, recurrence occurred in 5 of 42 patients (11.90%) and 13 of 42 patients (30.95%), respectively, corresponding to a risk difference of -19.05 percentage points (95% CI, -35.55 to -1.37) and a relative risk of 0.38 (95% CI, 0.15-0.98). Generalized estimating equations showed more favorable changes in psychological status, self-management, and nutritional indicators in the risk-guided group, whereas group-by-time interactions for compliance indicators were not significant. The risk-guided group also had lower measured resource use and higher nursing satisfaction. These findings are observational associations; the limited event count, possible temporal overlap between predictors and recurrence, the absence of external validation, and nonrandomized comparisons limit predictive and causal interpretation.