Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
Department of Geriatric Medicine, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China.
Gastric Cancer. 2023 Jul;26(4):590-603. doi: 10.1007/s10120-023-01391-4. Epub 2023 Apr 15.
Perforation is a common complication during endoscopic resection (ER) of gastric gastrointestinal stromal tumors (gGISTs) associated with secondary infections, sepsis, hospitalization time and cost. However, the risk factors of perforation remain controversial. This study aimed to investigate the risk factors for perforation during ER of gGISTs.
This retrospective case-control study included consecutive patients with gGISTs who underwent ER between June 2009 and November 2021 at the Nanjing Drum Tower Hospital. Univariate and multivariate analyses were performed to investigate the risk factors for perforation. Sensitivity analyses with propensity scoring (PS) were performed to evaluate the stability of the independent effects.
In total, 422 patients with gGISTs were included. The following factors were associated with perforation during ER: in the non-intraluminal growth patterns (all confounders adjusted odds ratio [aOR]: 5.39, 95% CI 2.99-9.72, P < 0.001), in the gastric fundus (aOR 2.25, 95% CI 1.40-3.60, P = 0.007), sized ≥ 2 cm (aOR 1.70, 95% CI 1.04-2.77, P = 0.035), in the lesser curvature (aOR 0.12, 95% CI 0.05-0.27, P < 0.001), and in the gastric cardia (aOR 0.13, 95% CI 0.04-0.50, P = 0.003). The PS analysis confirmed the stable independent effects of these identified risk factors.
ERs of gGISTs in non-intraluminal growth patterns, in the gastric fundus, and with larger tumor size were independent risk factors for perforation. While tumors in the lesser curvature or gastric cardia were independent protective factor for perforation.
穿孔是内镜下胃胃肠间质瘤（gGIST）切除术（ER）的常见并发症，可导致继发感染、脓毒症、住院时间和费用增加。然而，穿孔的危险因素仍存在争议。本研究旨在探讨 gGIST 内镜下切除穿孔的危险因素。
本回顾性病例对照研究纳入了 2009 年 6 月至 2021 年 11 月在南京鼓楼医院接受 ER 治疗的连续 gGIST 患者。采用单因素和多因素分析探讨穿孔的危险因素。采用倾向评分（PS）进行敏感性分析，以评估独立效应的稳定性。
共纳入 422 例 gGIST 患者。以下因素与 ER 期间穿孔相关：非腔内生长模式（所有混杂因素调整后优势比[aOR]：5.39，95%CI 2.99-9.72，P<0.001），胃底（aOR 2.25，95%CI 1.40-3.60，P=0.007），直径≥2cm（aOR 1.70，95%CI 1.04-2.77，P=0.035），胃小弯（aOR 0.12，95%CI 0.05-0.27，P<0.001），胃贲门（aOR 0.13，95%CI 0.04-0.50，P=0.003）。PS 分析证实了这些确定的危险因素具有稳定的独立效应。
非腔内生长模式、胃底和较大肿瘤直径的 gGIST ER 是穿孔的独立危险因素。而胃小弯或胃贲门的肿瘤是穿孔的独立保护因素。
