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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(04): E468-E478
DOI: 10.1055/a-1775-7976
Original article

A scoring system to support surgical decision-making for cardial submucosal tumors

Zi-Han Geng‡
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
,
Yan Zhu‡
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
,
Wei-Feng Chen‡
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
,
Shi-Yao Chen
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
,
Yun-Shi Zhong
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
,
Yi-Qun Zhang
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
,
Li-Li Ma
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
,
Wen-Zheng Qin
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
,
Jian-Wei Hu
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
,
Ming-Yan Cai
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
,
Li-Qing Yao
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
,
Quan-Lin Li
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
2   Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
,
Ping-Hong Zhou
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
2   Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
› Author AffiliationsSupported by: Shanghai Sailing Program of Shanghai Municipal Science and Technology Committee 19YF1406400
Supported by: National Key R&D Program of China 2019YFC1315800
Supported by: Major Project of Shanghai Municipal Science and Technology Committee 18ZR1406700 and 19441905200
Supported by: Shanghai Rising-Star Program 19QA1401900
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A scoring system to support surgical decision-making for cardial submucosal tumorsEndosc Int Open 2022; 10(04): C5-C5
DOI: 10.1055/a-1848-2266

Abstract

Background and study aims Submucosal tunneling endoscopic resection (STER) and non-tunneling techniques are two alternative options for the treatment of cardial submucosal tumors (SMTs). We aimed to establish a regression model and develop a simple scoring system (Zhongshan Tunnel Score) to help clinicians make surgical decisions for cardial submucosal tumors.

Patients and methods A total of 246 patients who suffered cardial SMTs and received endoscopic resection were included in this study. All of them were randomized into either the training cohort (n = 147) or the internal validation cohort (n = 99). Then, the scoring system was proposed based on multivariate logistic regression analysis in the training cohort and assessed in the validation cohort.

Results Of 246 patients, 97 were treated with STER and the others with non-tunneling endoscopic resection. In the training stage, four factors were weighted with points based on the β coefficient from the regression model, including irregular morphology (–2 points), ulcer (2 points), the direction of the gastroscope (–2 points for forward direction and 1 point for reverse direction), and originating from the muscularis propria (–2 points). The patients were categorized into low-score (< –4), medium-score (–4 to –3) and high-score (> –3) groups, and those with low scores were more likely to be treated with STER. Our score model performed satisfying discriminatory power in internal validation (Area under the receiver-operator characteristic curve, 0.829; 95 % confidence interval, 0.694–0.964) and goodness-of-fit in the Hosmer-Lemeshow test (P = .4721).

Conclusions This scoring system could provide clinicians the references for making decisions about the treatment of cardial submucosal tumors.

Supplementary material



Publication History

Received: 22 July 2021

Accepted after revision: 10 November 2021

Article published online:
14 April 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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