内镜黏膜下剥离术后电凝综合征预测的危险因素和列线图：用于浅大肠病变。
Risk factors and a nomogram for prediction of post-endoscopic submucosal dissection electrocoagulation syndrome for superficial colorectal lesions.
机构信息
Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China.
出版信息
Surg Endosc. 2024 Jul;38(7):3716-3727. doi: 10.1007/s00464-024-10886-9. Epub 2024 May 23.
BACKGROUND
Post-endoscopic submucosal dissection electrocoagulation syndrome (PEECS) is an uncommon complication after colorectal endoscopic submucosal dissection (ESD). This study aimed to explore the risk factors of PEECS for superficial colorectal lesions based on the latest and consistent diagnostic criteria and to establish a predictive nomogram model.
METHODS
This retrospective analysis included patients with superficial colorectal lesions who underwent endoscopic submucosal dissection (ESD) between June 2008 and December 2021 in our center. The independent risk factors of PEECS for superficial colorectal lesions were identified using least absolute shrinkage and selection operator (LASSO) logistic regression analysis, as well as univariate analysis and multivariate logistic regression, and derived predictive nomogram model was constructed.
RESULTS
Among the 555 patients with superficial colorectal lesions enrolled, PEECS occurred in 45 (8.1%) patients. Multivariate logistic regression revealed that female sex (OR 3.94, P < 0.001), age > 50 years (OR 4.28, P = 0.02), injury to muscle layer (OR 10.38, P < 0.001), non-lifting sign (OR 2.20, P = 0.04) and inadequate bowel preparation (OR 5.61, P < 0.001) were independent risk factors of PEECS for superficial colorectal lesions. A predictive nomogram model was constructed based on the above five predictors. For this model, the area under the receiver operating characteristic (ROC) curve was 0.855, the calibration curve exhibited good consistency between the prediction and the actual observation, and the C-index was confirmed as 0.843 by bootstrap method.
CONCLUSION
Female sex, age > 50 years, injury to muscle layer, non-lifting sign and inadequate bowel preparation were independent risk factors of PEECS for superficial colorectal lesions. The proposed nomogram could accurately predict the risk of PEECS for superficial colorectal lesions.
背景
内镜黏膜下剥离术后电凝综合征（PEECS）是结直肠内镜黏膜下剥离术（ESD）后一种罕见的并发症。本研究旨在基于最新且一致的诊断标准，探讨浅结直肠病变发生 PEECS 的危险因素，并建立预测列线图模型。
方法
本回顾性分析纳入 2008 年 6 月至 2021 年 12 月期间在我中心接受内镜黏膜下剥离术（ESD）的浅结直肠病变患者。采用最小绝对收缩和选择算子（LASSO）逻辑回归分析、单因素分析和多因素逻辑回归分析，确定浅结直肠病变发生 PEECS 的独立危险因素，并构建预测列线图模型。
结果
在纳入的 555 例浅结直肠病变患者中，45 例（8.1%）发生 PEECS。多因素逻辑回归分析显示，女性（OR=3.94，P<0.001）、年龄>50 岁（OR=4.28，P=0.02）、损伤肌层（OR=10.38，P<0.001）、无抬举征（OR=2.20，P=0.04）和肠道准备不充分（OR=5.61，P<0.001）是浅结直肠病变发生 PEECS 的独立危险因素。基于以上 5 个预测因子构建了预测列线图模型。该模型的受试者工作特征曲线（ROC）下面积为 0.855，校准曲线显示预测与实际观察之间具有良好的一致性，Bootstrap 法验证的 C 指数为 0.843。
结论
女性、年龄>50 岁、损伤肌层、无抬举征和肠道准备不充分是浅结直肠病变发生 PEECS 的独立危险因素。所提出的列线图能够准确预测浅结直肠病变发生 PEECS 的风险。
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