Innovative development and validation of a scoring system for predicting electrocoagulation syndrome post-endoscopic submucosal dissection of gastric gastrointestinal stromal tumors.

BACKGROUND

Post-endoscopic submucosal dissection electrocoagulation syndrome (PEECS) is a critical complication following endoscopic resection of gastric gastrointestinal stromal tumors (gGISTs). However, validated tools for predicting PEECS risk remain limited. This study aimed to develop and validate a scoring system to stratify PEECS risk in patients undergoing endoscopic submucosal dissection (ESD).

METHODS

A multicenter retrospective analysis included 618 patients with gGISTs treated with ESD between January 2011 and December 2024. Cohorts were stratified into a training cohort (TC, N = 346), an internal validation cohort (IVC, N = 148), and an external validation cohort (EVC, N = 124). Univariate and multivariate logistic regression analyses identified independent risk factors, which were weighted by regression coefficients to construct a scoring system. Performance metrics, including area under the curve (AUC), sensitivity, specificity, and predictive values, were evaluated across cohorts.

RESULTS

PEECS occurred in 89 cases (14.4%). Multivariate analysis confirmed that circumferential tumor location, severe intraoperative bleeding, and prolonged procedure time as independent predictors. The scoring system assigned points as follows: anterior wall location (2 points), occurrence of severe intraoperative bleeding (3 points), and procedure time ≥ 60 min (1 point). The scoring system demonstrated robust discrimination, with AUCs of 0.838 (IVC) and 0.842 (EVC), and high negative predictive values (NPV: 95.6% and 92.1%, respectively). PEECS incidence escalated with risk strata: low-risk (score 0-1: 4.8% TC, 4.4% IVC, 5.5% EVC), intermediate-risk (score 2-3: 21.6% TC, 21.6% IVC, 25.0% EVC), and high-risk (score 4-6: 92.3% TC, 100.0% IVC/EVC).

CONCLUSION

This innovative scoring system, integrating tumor location, intraoperative bleeding, and procedure duration, provides a practical tool for predicting PEECS risk. Its robust validation across cohorts underscores its potential utility in guiding perioperative management and improving patient outcomes. Clinicians may use this tool to identify high-risk patients and implement preventive strategies proactively.