Construction And Validation Of A Predictive Model For Esophageal Stricture Risk After Endoscopic Submucosal Dissection

Goals:By investigating the independent risk factors of esophageal stricture after endoscopic submucosal dissection for early esophageal cancer and precancerous lesions,and then constructing and validating a nomogram model to predict the risk of postoperative esophageal stricture,it provides a theoretical basis for preventing postoperative esophageal stricture and guiding clinical practice.Methods:The clinical basic data,auxiliary examinations,and questionnaire data of patients with early esophageal cancer and precancerous lesions who underwent endoscopic submucosal dissection(ESD)in Affiliated Hospital of North Sichuan Medical College from March 2017 to August 2021 were retrospectively collected.A total of 256 patients were included in this study.Univariate analysis and multivariate logistic regression analysis were used to determine the independent risk factors for esophageal stenosis after ESD,and a nomogram model was established based on the independent variable regression coefficient of the results.The predictive value of this model was evaluated by plotting the receiver operating characteristic curve(ROC)and calibration curve,and the Bootstrap method was used to internally validate the model.Finally,we assessed the sensitivity and specificity of the model constructed in previous studies using the extent of mucosal dissection and the depth of tissue invasion alone as predictors and further validated the predictive performance of several indicators in this study by comparing the area under the ROC curve(AUC).Results:Age more than 60 years(P=0.003,OR=11.229,95%CI:2.315-54.466),long-term drinking temperature(P<0.001,OR=13.378,95%CI:3.987-44.882),preoperative high grade lymphocyte ratio(NLR)(P=0.003,OR=5.65,95%CI:1.782-17.917),percentage of resected mucosal defect(PCMD)more than 3/4(P<0.001,OR=8.564,95%CI:2.58728.355),and longitudinal diameter of resected mucosa(LD)more than 4 cm(P=0.029,OR=1.422,95%CI:1.036-1.951),and the depth of tissue invasion reaching more than M2(P=0.004,OR=4.433,95%CI:1.60212.272)were independent risk factors for esophageal stenosis after ESD.The AUC of the nomogram model constructed using R software was 0.925,and the sensitivity of this model was 89.5%and the specificity was 79.8%when the Youden index was 0.69.The calibration curve shows that the prediction results of this nomogram model are in good agreement with the actual observations.Several measures in this study had higher predictive performance compared to known predictors(P<0.05).Conclusions:Age,drinking temperature,neutrophil-lymphocyte ratio,the extent of esophageal mucosal defect,longitudinal diameter of resected mucosa,and depth of tissue invasion were independent risk factors for esophageal stricture after ESD.The nomogram model constructed in this study has high accuracy in predicting the risk of esophageal stricture after ESD,which helps to improve people’s understanding of esophageal stricture after ESD,while providing a theoretical basis for preventing esophageal stricture and guiding clinical practice.