Sun GY, Gao TJ, Sun Y, Jia W, Yang Z. Risk factors with nomogram construction for moderate to severe pain after endoscopic full-thickness resection. World J Gastroenterol 2025; 31(44): 112576 [DOI: 10.3748/wjg.v31.i44.112576]
Corresponding Author of This Article
Zhuo Yang, Chief Physician, Professor, Department of Endoscopy, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, Shenyang 110000, Liaoning Province, China. yangzhuocy@163.com
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Gastroenterology & Hepatology
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Retrospective Study
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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/
Nov 28, 2025 (publication date) through Dec 1, 2025
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World Journal of Gastroenterology
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1007-9327
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Sun GY, Gao TJ, Sun Y, Jia W, Yang Z. Risk factors with nomogram construction for moderate to severe pain after endoscopic full-thickness resection. World J Gastroenterol 2025; 31(44): 112576 [DOI: 10.3748/wjg.v31.i44.112576]
World J Gastroenterol. Nov 28, 2025; 31(44): 112576 Published online Nov 28, 2025. doi: 10.3748/wjg.v31.i44.112576
Risk factors with nomogram construction for moderate to severe pain after endoscopic full-thickness resection
Guo-Yao Sun, Teng-Jiao Gao, Yong Sun, Wen Jia, Zhuo Yang
Guo-Yao Sun, Teng-Jiao Gao, Yong Sun, Wen Jia, Zhuo Yang, Department of Endoscopy, General Hospital of Northern Theater Command, Shenyang 110000, Liaoning Province, China
Co-first authors: Guo-Yao Sun and Teng-Jiao Gao.
Co-corresponding authors: Yong Sun and Zhuo Yang.
Author contributions: Sun GY contributed to data curation and visualization; Gao TJ performed formal analysis and software development; Sun GY and Gao TJ contributed equally to this article, they are the co-first authors of this manuscript; Jia W contributed to methodology and manuscript editing; Sun Y and Yang Z were responsible for conceptualization and supervision, they contributed equally to this article, they are the co-corresponding authors of this manuscript; and all authors thoroughly reviewed and endorsed the final manuscript.
Supported by the Shenyang Bureau of Science and Technology, No. 22-321-32-15.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the General Hospital of Northern Theater Command, approval No. Y (2025) 332.
Informed consent statement: This retrospective study used existing clinical data and was approved by the Ethics Committee, with informed consent waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data generated in this study are available from the corresponding author upon reasonable request.
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: Zhuo Yang, Chief Physician, Professor, Department of Endoscopy, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, Shenyang 110000, Liaoning Province, China. yangzhuocy@163.com
Received: July 31, 2025 Revised: September 6, 2025 Accepted: October 20, 2025 Published online: November 28, 2025 Processing time: 120 Days and 13.9 Hours
Abstract
BACKGROUND
Endoscopic full-thickness resection (EFTR) is an effective treatment for gastrointestinal lesions. Compared with endoscopic submucosal dissection, EFTR is associated with a higher incidence of postoperative pain, particularly moderate to severe pain, which can significantly impact patients’ quality of life and recovery. Although some studies have focused on postoperative analgesia, clinical evidence regarding the underlying mechanisms and risk factors of pain after EFTR - especially moderate to severe pain following upper gastrointestinal EFTR - remains limited.
AIM
To identify risk factors for moderate to severe pain following EFTR and to construct a predictive nomogram for clinical use.
METHODS
We conducted a retrospective analysis of patients who underwent EFTR at our center between October 1, 2019, and June 1, 2025. Univariate and multivariate logistic regression analyses were performed to identify risk factors associated with postoperative moderate to severe pain following EFTR. A nomogram was subsequently constructed based on a multivariate logistic regression model to predict the risk of moderate to severe pain following EFTR. The discrimination and calibration of the nomogram were evaluated by estimating the area under the receiver operator characteristic curve and by bootstrap resampling and visual inspection of the calibration curve. The clinical utility of the nomogram was assessed using decision curve analysis.
RESULTS
A total of 172 patients who underwent EFTR were included in the study, of whom 27 (15.7%) experienced moderate to severe postoperative pain. Based on multivariate logistic regression analysis, higher body mass index was significantly associated with a reduced risk of moderate to severe postoperative pain [odds ratio (OR) = 0.83, 95% confidence interval (CI): 0.72-0.95, P = 0.0091], while a lesion size ≥ 3 cm (OR = 12.01, 95%CI: 3.03-47.68, P = 0.0004) and benign lesions (OR = 12.12, 95%CI: 2.70-54.49, P = 0.0011) were significantly associated with an increased risk. The nomogram demonstrated excellent discriminatory ability, with an area under the curve of 0.792 (95%CI: 0.690-0.894), a sensitivity of 63%, and a specificity of 84%. The calibration curve showed excellent agreement between predicted and observed probabilities (mean absolute error = 0.022). Subsequent decision curve analysis further confirmed the nomogram’s clinical utility.
CONCLUSION
In this study, we successfully developed a predictive nomogram for identifying the risk of moderate to severe pain following EFTR surgery.
Core Tip: Endoscopic full-thickness resection (EFTR) is increasingly used for gastrointestinal lesion treatment but is often complicated by moderate to severe postoperative pain. This retrospective study identifies key risk factors, including body mass index, lesion size, and lesion nature, associated with postoperative pain after EFTR. A novel nomogram was developed to predict individual patient risk, demonstrating strong predictive accuracy and clinical utility. This tool may guide personalized pain management strategies, improving patient recovery and quality of life after EFTR.
