Scoring system supporting suture decision-making for duodenal submucosal tumors.

Abstract

Background: In recent years, endoscopic resection (ER) has been employed for the excision of submucosal tumors (SMTs). Nonetheless, ER in the duodenum is linked to elevated risks of both immediate and delayed hemorrhagic complications and perforations. Satisfactory suturing is crucial for reducing the occurrence of complications.

Aim: To establish a clinical score model for supporting suture decision-making of duodenal SMTs.

Methods: This study included 137 individuals diagnosed with duodenal SMTs who underwent ER. Participants were evenly divided into two groups: A training cohort (TC) comprising 95 cases and an internal validation cohort (VC) with 42 cases. Subsequently, a scoring system was formulated utilizing multivariate logistic regression analysis within the TC, which was then subjected to evaluation in the VC.

Results: The clinical scoring system incorporated two key factors: Extraluminal growth, which was assigned 2 points, and endoscopic full-thickness resection, which was given 3 points. This model demonstrated strong predictive accuracy, as evidenced by the area under the receiver operating characteristic curve of 0.900 (95% confidence interval: 0.823-0.976). Additionally, the model's goodness-of-fit was validated by the Hosmer-Lemeshow test (P = 0.404). The probability of purse-string suturing in low (score 0-2) and high (score > 3) categories were 3.0% and 64.3% in the TC, and 6.1% and 88.9% in the VC, respectively.

Conclusion: This scoring system may function as a beneficial instrumentality for medical practitioners, facilitating the decision-making process concerning suture techniques in the context of duodenal SMTs.