Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Mar 24, 2025; 16(3): 100030
Published online Mar 24, 2025. doi: 10.5306/wjco.v16.i3.100030
Scoring system supporting suture decision-making for duodenal submucosal tumors
Zi-Han Geng, Yi-Fan Qu, Yan Zhu, Pei-Yao Fu, Wei-Feng Chen, Quan-Lin Li, Ping-Hong Zhou
Zi-Han Geng, Yi-Fan Qu, Yan Zhu, Pei-Yao Fu, Wei-Feng Chen, Quan-Lin Li, Ping-Hong Zhou, Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Zi-Han Geng, Yi-Fan Qu, Yan Zhu, Pei-Yao Fu, Wei-Feng Chen, Quan-Lin Li, Ping-Hong Zhou, Shanghai Collaborative Innovation Center of Endoscopy, Shanghai 200032, China
Co-first authors: Zi-Han Geng and Yi-Fan Qu.
Co-corresponding authors: Quan-Lin Li and Ping-Hong Zhou.
Author contributions: Geng ZH, Qu YF, Zhu Y, Fu PY, Chen WF, Li QL, and Zhou PH generated conception; Geng ZH and Qu FY, analyzed data, prepared software, wrote, reviewed, and edited the draft, they contributed equally as co-first authors; Fan Y, Zhu Y, and Fu PY prepared software, wrote, reviewed, and edited the draft; Li QL and Zhou PH supervised the study, they contributed equally as co-corresponding authors.
Supported by National Natural Science Foundation of China, No. 82170555; Shanghai Academic/Technology Research Leader, No. 22XD1422400; Shanghai “Rising Stars of Medical Talent” Youth Development Program, No. 20224Z0005; the 74th General Support of China Postdoctoral Science Foundation, No. 2023M740675; and Outstanding Resident Clinical Postdoctoral Program of Zhongshan Hospital Affiliated to Fudan University.
Institutional review board statement: This study was approved by the Ethics Committee of the Zhongshan Hospital, in accordance with the Declaration of Helsinki (No. B-2018-222).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: For legitimate requests, the author can provide the relevant data.
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: Ping-Hong Zhou, MD, Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China. zhou.pinghong@zs-hospital.sh.cn
Received: August 6, 2024
Revised: October 23, 2024
Accepted: December 20, 2024
Published online: March 24, 2025
Processing time: 168 Days and 5 Hours
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.

Keywords: Endoscopic resection; Duodenal submucosal tumors; Clinical score model; Suturing technique; Submucosal tumors

Core Tip: Endoscopic resection of duodenal submucosal tumors carries high risks of hemorrhage and perforation, highlighting the importance of effective suturing. Thus, we established a clinical score model for supporting suture decision-making of duodenal submucosal tumors. The clinical score comprised extraluminal growth (2 points) and endoscopic full-thickness resection (3 points) with good discriminatory power. The scoring system could provide endoscopists the references for supporting suture decision-making of duodenal submucosal tumors.