Scoring system supporting suture decision-making for duodenal submucosal tumors

Table 1 Demographic information, lesion characteristics and procedural outcomes of the two different suturing techniques, n (%)

	Metal clip (n = 107)	Purse-string suturing (n = 30)	P value
Demographic information
Male	55 (51.4)	15 (50.0)	0.892
Age (years), mean ± SD	53.8 ± 11.8	50.8 ± 10.8	0.215
Hypertension	29 (27.1)	5 (16.7)	0.242
Diabetes mellitus	5 (4.7)	0 (0.0)	0.512
Lesion characteristics
Growth pattern			< 0.001
Intraluminal growth	105 (98.1)	15 (50.0)
Extraluminal growth	2 (1.9)	15 (50.0)
Morphology			0.490
Regular	97 (90.7)	29 (96.7)
Irregular	10 (9.3)	1 (3.3)
Mucosa			0.321
Smooth	90 (84.1)	28 (93.3)
Anabrotic or ulcerative	17 (15.9)	2 (6.7)
Location			0.269
Duodenal bulb	49 (45.8)	19 (63.3)
Descending part (near the papilla)	17 (15.9)	2 (6.7)
Descending part (not near the papilla)	40 (37.4)	9 (30.0)
Horizontal part	1 (0.9)	0 (0.0)
Infiltration depth			< 0.001
Submucosa	81 (75.7)	5 (16.7)
Muscularis propria	26 (24.3)	25 (83.3)
Max diameter (mm), mean ± SD	12.9 ± 7.0	14.6 ± 6.8	0.227
Procedural outcomes
Endoscopic methods
Electric cutting	3 (2.8)	0 (0.0)	0.220
EMR	28 (26.2)	0 (0.0)	0.002
ESD	62 (57.9)	3 (10.0)	< 0.001
EFTR	11 (10.3)	26 (86.7)	< 0.001
EPMR	3 (2.8)	1 (3.3)	0.881
Intraoperative endoscopic instruments
Hook knife	30 (28.0)	9 (30.0)	0.833
Dual knife	8 (7.5)	2 (6.7)	1.000
IT knife	40 (37.4)	9 (30.0)	0.456
Snare	45 (42.1)	16 (53.3)	0.272
Histopathologic evaluation
Ectopic pancreas	24 (22.4)	5 (16.7)	0.495
Lipoma	14 (13.1)	0 (0.0)	0.080
NET	16 (15.0)	1 (3.3)	0.164
GIST	12 (11.2)	17 (56.7)	< 0.001
Brunner’s gland adenoma	33 (30.8)	4 (13.3)	0.056
Others	8 (7.5)	3 (10.0)	0.945
Submucosal fibrosis	10 (9.3)	2 (6.7)	0.926
En-bloc resection	84 (78.5)	23 (76.7)	0.830
Complete resection	84 (78.5)	23 (76.7)	0.830
Stomach tube	64 (59.8)	29 (96.7)	< 0.001
Surgery time (minute), mean ± SD	30.2 ± 25.5	60.9 ± 32.3	< 0.001
Hospital stay (day), mean ± SD	5.1 ± 9.4	8.9 ± 10.5	0.059
Complications	6 (5.6)	2 (6.7)	1.000

EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; EFTR: Endoscopic full-thickness resection; EPMR: Endoscopic piecemeal mucosal resection; NET: Neuroendocrine tumor; GIST: Gastrointestinal Stromal Tumor.

Table 2 Multivariate logistic regression analysis for predicting suturing methods of duodenal submucosal tumors

Factors	OR (95%CI)	β coefficient	P value	Point assigned
Growth pattern
Intraluminal growth	1
Extraluminal growth	6.694 (1.212-55.684)	1.901	0.044	2
Infiltration depth
Submucosa	1
Muscularis propria	1.237 (0.049-13.673)	0.213	0.873	NA
Endoscopic methods
Non-full-thickness resection	1
EFTR	30.518 (3.251-788.983)	3.418	0.009	3
Histopathologic evaluation
GIST	0.606 (0.095-3.371)	-0.502	0.575	NA
Non-GIST	1

OR: Odds ratio; CI: Confidence interval; NA: Not available; EFTR: Endoscopic full-thickness resection; GIST: Gastrointestinal Stromal Tumor.

Table 3 Distribution of scores for predicting suturing methods of duodenal submucosal tumors in the training and validation cohorts

Total points	TC, patients (n = 95)	TC, combination (n = 20)	TC, combination rate (%)	VC, patients (n = 42)	VC, combination (n = 10)	VC, combination rate (%)
0	67	2	3.0	33	2	6.1
3	15	7	46.7	5	4	80.0
5	13	11	84.6	4	4	100.0

TC: Training cohort; VC: Validation cohort.

Table 4 Classification for predicting suturing methods of duodenal submucosal tumors in the training and validation cohorts

Category	Total points	TC, patients (n = 95)	TC, purse-string suturing (n = 20)	TC, rate (%)	VC, patients (n = 42)	VC, purse-string suturing (n = 10)	VC, pate (%)
Low	67	2	3.0	33	2	6.1
High	≥ 3	28	18	64.3	9	8	88.9

TC: Training cohort; VC: Validation cohort.