Zhang DM, Li PP, Zhang MH, Zhao ZX, Zhou YB. Postoperative perforation risk after endoscopic removal of gastric gastrointestinal stromal tumors: Development and validation of a predictive nomogram. World J Gastrointest Endosc 2025; 17(10): 110920 [DOI: 10.4253/wjge.v17.i10.110920]
Corresponding Author of This Article
Zong-Xian Zhao, MD, Department of Anorectal Surgery, Fuyang People’s Hospital Affiliated to Bengbu Medical University, No. 501 Sanqing Road, Yingzhou District, Fuyang 236000, Anhui Province, China. 461901580@qq.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/
Oct 16, 2025 (publication date) through Oct 19, 2025
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World Journal of Gastrointestinal Endoscopy
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1948-5190
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Zhang DM, Li PP, Zhang MH, Zhao ZX, Zhou YB. Postoperative perforation risk after endoscopic removal of gastric gastrointestinal stromal tumors: Development and validation of a predictive nomogram. World J Gastrointest Endosc 2025; 17(10): 110920 [DOI: 10.4253/wjge.v17.i10.110920]
World J Gastrointest Endosc. Oct 16, 2025; 17(10): 110920 Published online Oct 16, 2025. doi: 10.4253/wjge.v17.i10.110920
Postoperative perforation risk after endoscopic removal of gastric gastrointestinal stromal tumors: Development and validation of a predictive nomogram
Dong-Mei Zhang, Pan-Pan Li, Min-Hui Zhang, Ya-Bo Zhou, Department of Gastroenterology, Fuyang People’s Hospital Affiliated to Bengbu Medical University, Fuyang 236000, Anhui Province, China
Zong-Xian Zhao, Department of Anorectal Surgery, Fuyang People’s Hospital Affiliated to Bengbu Medical University, Fuyang 236000, Anhui Province, China
Co-first authors: Dong-Mei Zhang and Pan-Pan Li.
Co-corresponding authors: Zong-Xian Zhao and Ya-Bo Zhou.
Author contributions: Zhang DM and Li PP collected the clinical data, they contributed equally to this manuscript and are co-first authors; Zhang MH drew the tables; Zhao ZX and Zhou YB designed and refined the study, they contributed equally to this manuscript and are co-corresponding authors; Zhang DM and Zhao ZX wrote and completed the manuscript.
Institutional review board statement: This study was conducted in accordance with the Declaration of Helsinki, and all procedures were approved by the Ethics Committee of Fuyang People’s Hospital, No.[2024]166.
Informed consent statement: Written informed consent was obtained from all participants prior to their involvement in the study, including consent for the publication of any potentially identifiable images or data included in this article. The data used in this study were anonymized and de-identified prior to analysis.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data is available.
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: Zong-Xian Zhao, MD, Department of Anorectal Surgery, Fuyang People’s Hospital Affiliated to Bengbu Medical University, No. 501 Sanqing Road, Yingzhou District, Fuyang 236000, Anhui Province, China. 461901580@qq.com
Received: June 19, 2025 Revised: July 19, 2025 Accepted: September 16, 2025 Published online: October 16, 2025 Processing time: 120 Days and 0 Hours
Abstract
BACKGROUND
Gastrointestinal stromal tumors are the most common mesenchymal tumors of the gastrointestinal tract, and gastric gastrointestinal stromal tumors (gGISTs) account for the majority of these tumors. Currently, endoscopic removal (ER) is increasingly adopted as a minimally invasive treatment. However, postoperative perforation remains a critical complication, necessitating robust prediction tools.
AIM
To identify the risk factors and develop a validated nomogram for predicting perforation after ER of gGISTs.
METHODS
This retrospective study analyzed the patients undergoing ER at Fuyang People’s Hospital from 2019 to 2024. Clinical data, including tumor size, location, and procedural details, were collected and analyzed. The risk factors were identified via univariate and multivariate logistic regression, and a nomogram was developed. Both internal and external validations were performed, and the model performance was assessed by receiver operating characteristic curves and calibration plots.
RESULTS
Among 301 patients, the perforation rate was 6.3%. Multivariate analysis identified tumor size (odds ratio = 4.699, 95% confidence interval: 2.382-9.267, P = 0.001) and cardia/fundus location (odds ratio = 3.492, 95% confidence interval: 1.121-10.875, P = 0.031) as independent predictors. A nomogram was constructed and achieved good predictive performance in both the training (area under the curve = 0.881) and validation sets (area under the curve = 0.878).
CONCLUSION
This study identified that tumor size and location were independent risk factors, and provides a clinically actionable nomogram for evaluating and predicting postoperative perforation risk in gGISTs treated with ER, facilitating preprocedural planning and risk monitoring.
Core Tip: Gastric gastrointestinal stromal tumors are the most common mesenchymal tumors of the gastrointestinal tract, with endoscopic resection being a preferred minimally invasive treatment. Postoperative perforation is a severe complication, necessitating a robust predictive tool. In this retrospective study, we enrolled 301 patients who underwent endoscopic removal for gastric gastrointestinal stromal tumors at Fuyang People’s Hospital. Risk factors were identified via univariate and multivariate logistic regression. A nomogram was then constructed and validated. Multivariate analysis identified tumor size and cardia/fundus location as independent risk factors. The nomogram showed good predictive performance, with an area under the receiver operating characteristic curve of 0.881 in the training cohort and 0.878 in the validation cohort, with calibration curves demonstrating consistency between predicted and observed perforation rates.
