A scoring system to predict the technical difficulty of endoscopic resection for cardial submucosal tumors

Zi-Han Geng; Yi-Fan Qu; Pei-Yao Fu; Yan Zhu; Wei-Feng Chen; Quan-Lin Li; Ping-Hong Zhou

doi:10.1111/jgh.16542

A scoring system to predict the technical difficulty of endoscopic resection for cardial submucosal tumors

J Gastroenterol Hepatol. 2024 Apr 1. doi: 10.1111/jgh.16542. Online ahead of print.

Authors

Zi-Han Geng^{1

2}, Yi-Fan Qu^{1

2}, Pei-Yao Fu^{1

2}, Yan Zhu^{1

2}, Wei-Feng Chen^{1

2}, Quan-Lin Li^{1

2}, Ping-Hong Zhou^{1

2}

Affiliations

¹ Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
² Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China.

PMID: 38561861
DOI: 10.1111/jgh.16542

Abstract

Background and aim: Endoscopic resection has been successfully used for the removal of digestive submucosal tumors (SMTs). However, the cardia has been considered a challenging location for endoscopic resection due to its narrow lumen and sharp angle. The objective of this study was to establish a clinical scoring model to grade the technical difficulty of endoscopic resection for cardial SMTs.

Methods: A total of 246 patients who suffered cardial SMTs and received endoscopic resection were included in this retrospective study. All of them were randomized into the training cohort (n = 123) or internal validation cohort (n = 123). Potential predictors were analyzed using univariate analysis. Then, covariates with P < 0.05 were selected for the multivariate logistic regression model. The β coefficients from the logistic regression model were used to create a scoring system for technical difficulty prediction by rounding the score to the nearest integer of the absolute β coefficient value.

Results: The clinical score consisted of the following factors: male gender (2 points), extraluminal growth (3 points), and maximum diameter ≥3 cm (3 points). The scoring model demonstrated good discriminatory power, with an area under the receiver operating characteristic curve of 0.860 and a 95% confidence interval of 0.763-0.958. The model also showed a good goodness of fit in the Hosmer-Lemeshow test (P = 0.979). In the training cohort, the probability of encountering technical difficulty in the easy (score = 0), intermediate (score = 1-3), difficult (score = 4-6), and very difficult (score >6) categories was 0, 6.8%, 33.3%, and 100.0%, respectively; similarly, in the validation cohort, it was 0, 5.6%, 22.2%, and 50.0%, respectively.

Conclusions: This scoring system could serve as a valuable tool for clinicians in predicting the technical difficulty of endoscopic resection for cardial SMTs.

Keywords: cardial submucosal tumors; clinical score model; endoscopic resection; technical difficulty.

Abstract

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