Jia Y, Wu HJ, Li T, Liu JB, Fang L, Liu ZM. Establishment of predictive models and determinants of preoperative gastric retention in endoscopic retrograde cholangiopancreatography. World J Gastrointest Surg 2024; 16(8): 2574-2582 [PMID: 39220084 DOI: 10.4240/wjgs.v16.i8.2574]
Corresponding Author of This Article
Zi-Ming Liu, MD, Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu 610041, Sichuan Province, China. lzm2210736@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Ying Jia, Jia-Bin Liu, Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Hao-Jun Wu, Zi-Ming Liu, Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Tang Li, Ling Fang, Division of General Surgery, West China Hospital-Chengdu Shangjin Nanfu, West China Hospital, Chengdu 611730, Sichuan Province, China
Author contributions: Jia Y and Liu ZM designed the experiments and conducted clinical data collection; Wu HJ, Li T, Liu JB and Fang L performed postoperative follow-up and recorded the data; Jia Y and Liu ZM conducted the collation and statistical analysis, wrote the original manuscript and revised the paper; all authors read and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of West China Hospital of Sichuan University (No. 2022-1674).
Informed consent statement: The Ethics Committee has agreed to waive informed consent.
Conflict-of-interest statement: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data sharing statement: All data generated or analyzed during this study are included in this published article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zi-Ming Liu, MD, Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu 610041, Sichuan Province, China. lzm2210736@163.com
Received: May 16, 2024 Revised: July 2, 2024 Accepted: July 5, 2024 Published online: August 27, 2024 Processing time: 92 Days and 2.6 Hours
Abstract
BACKGROUND
Study on influencing factors of gastric retention before endoscopic retrograde cholangiopancreatography (ERCP) background: With the wide application of ERCP, the risk of preoperative gastric retention affects the smooth progress of the operation. The study found that female, biliary and pancreatic malignant tumor, digestive tract obstruction and other factors are closely related to gastric retention, so the establishment of predictive model is very important to reduce the risk of operation.
AIM
To analyze the factors influencing preoperative gastric retention in ERCP and establish a predictive model.
METHODS
A retrospective analysis was conducted on 190 patients admitted to our hospital for ERCP preparation between January 2020 and February 2024. Patient baseline clinical data were collected using an electronic medical record system. Patients were randomly matched in a 1:4 ratio with data from 190 patients during the same period to establish a validation group (n = 38) and a modeling group (n = 152). Patients in the modeling group were divided into the gastric retention group (n = 52) and non-gastric retention group (n = 100) based on whether gastric retention occurred preoperatively. General data of patients in the validation group and modeling group were compared. Univariate and multivariate logistic regression analyses were performed to identify factors influencing preoperative gastric retention in ERCP patients. A predictive model for preoperative gastric retention in ERCP patients was constructed, and calibration curves were used for validation. The receiver operating characteristic (ROC) curve was analyzed to evaluate the predictive value of the model.
RESULTS
We found no statistically significant difference in general data between the validation group and modeling group (P > 0.05). The comparison of age, body mass index, hypertension, and diabetes between the two groups showed no statistically significant difference (P > 0.05). However, we noted statistically significant differences in gender, primary disease, jaundice, opioid use, and gastrointestinal obstruction between the two groups (P < 0.05). Multivariate logistic regression analysis showed that gender, primary disease, jaundice, opioid use, and gastrointestinal obstruction were independent factors influencing preoperative gastric retention in ERCP patients (P < 0.05). The results of logistic regression analysis revealed that gender, primary disease, jaundice, opioid use, and gastrointestinal obstruction were included in the predictive model for preoperative gastric retention in ERCP patients. The calibration curves in the training set and validation set showed a slope close to 1, indicating good consistency between the predicted risk and actual risk. The ROC analysis results showed that the area under the curve (AUC) of the predictive model for preoperative gastric retention in ERCP patients in the training set was 0.901 with a standard error of 0.023 (95%CI: 0.8264-0.9567), and the optimal cutoff value was 0.71, with a sensitivity of 87.5 and specificity of 84.2. In the validation set, the AUC of the predictive model was 0.842 with a standard error of 0.013 (95%CI: 0.8061-0.9216), and the optimal cutoff value was 0.56, with a sensitivity of 56.2 and specificity of 100.0.
CONCLUSION
Gender, primary disease, jaundice, opioid use, and gastrointestinal obstruction are factors influencing preoperative gastric retention in ERCP patients. A predictive model established based on these factors has high predictive value.
Core Tip: The innovation of the study of gastric retention before endoscopic retrograde cholangiopancreatography lies in the accurate prediction of gastric retention by GCSI scale. It is found that female, biliary and pancreatic malignant tumor and digestive tract obstruction are independent risk factors. The important arguments are: Establishing a highly accurate prediction model, identifying high-risk patients in advance, and optimizing preoperative preparation.
