Academic Journal
Risk factors and predictive model for gas-related adverse events following peroral endoscopic myotomy.
| Τίτλος: | Risk factors and predictive model for gas-related adverse events following peroral endoscopic myotomy. |
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| Συγγραφείς: | Geng ZH; Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, People's Republic of China. 15750585959@163.com.; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, People's Republic of China. 15750585959@163.com., Liu XY; Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, People's Republic of China.; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, People's Republic of China., Zhang Z; Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, People's Republic of China.; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, People's Republic of China., Wan MY; Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, People's Republic of China.; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, People's Republic of China., Zhu Y; Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, People's Republic of China.; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, People's Republic of China., Fu PY; Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, People's Republic of China.; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, People's Republic of China., Tan YF; Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, People's Republic of China.; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, People's Republic of China., Li QL; Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, People's Republic of China. li.quanlin@zs-hospital.sh.cn.; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, People's Republic of China. li.quanlin@zs-hospital.sh.cn., Zhou PH; Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, People's Republic of China. zhou.pinghong@zs-hospital.sh.cn.; Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, People's Republic of China. zhou.pinghong@zs-hospital.sh.cn. |
| Πηγή: | Surgical endoscopy [Surg Endosc] 2026 Sep; Vol. 40 (9), pp. 7845-7850. Date of Electronic Publication: 2026 Jul 13. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Springer Country of Publication: Germany NLM ID: 8806653 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-2218 (Electronic) Linking ISSN: 09302794 NLM ISO Abbreviation: Surg Endosc Subsets: MEDLINE |
| Imprint Name(s): | Publication: 1992- : New York : Springer Original Publication: [Berlin] : Springer International, c1987- |
| Ιατρικοί όροι (MeSH): | Postoperative Complications*/etiology , Postoperative Complications*/epidemiology , Subcutaneous Emphysema*/etiology , Subcutaneous Emphysema*/epidemiology , Myotomy*/adverse effects , Myotomy*/methods , Natural Orifice Endoscopic Surgery*/adverse effects , Natural Orifice Endoscopic Surgery*/methods , Mediastinal Emphysema*/etiology , Mediastinal Emphysema*/epidemiology , Pneumothorax*/etiology , Pneumothorax*/epidemiology , Pneumoperitoneum*/etiology , Pneumoperitoneum*/epidemiology , Esophageal Achalasia*/surgery, Insufflation/adverse effects ; Humans ; Retrospective Studies ; Risk Factors ; Female ; Male ; Middle Aged ; Prediction Algorithms ; Aged |
| Περίληψη: | Background and Aims: Gas-related adverse events (GRAEs) are common after peroral endoscopic myotomy (POEM). Although air insufflation is a recognized risk factor, determinants of GRAEs in the era of carbon dioxide insufflation remain unclear. We aimed to identify independent risk factors after excluding air-insufflation cases and to develop and validate a clinically applicable prediction model. Methods: We retrospectively analyzed 3965 consecutive patients who underwent POEM between 2011 and 2024 at a tertiary referral center. GRAEs were defined as pneumoperitoneum, pneumothorax, pneumomediastinum, or subcutaneous emphysema requiring intervention. Patients were randomly allocated to training (80%) and validation (20%) cohorts. Independent predictors were identified using multivariable logistic regression in the training cohort. Model performance was evaluated in the validation cohort using discrimination (AUC) and calibration. Results: GRAEs occurred in 298 patients (7.5%). Multivariable analysis identified mucosal edema (OR 1.97; 95% CI 1.33-2.89), tunnel length ≥ 13 cm (OR 2.75; 95% CI 1.95-3.94), selective myotomy (OR 11.81; 95% CI 8.63-16.18), and mucosal injury (OR 2.52; 95% CI 1.74-3.62) as independent predictors (all P ≤ 0.001). Patients were stratified into low- (< 2 factors) and high-risk (≥ 2 factors) groups with significantly different GRAE rates. The model demonstrated good discrimination (AUC 0.763; 95% CI 0.732-0.794) and satisfactory calibration. Conclusions: We developed and internally validated a practical risk prediction model for GRAEs after POEM in the carbon dioxide era. This model may facilitate risk stratification and individualized perioperative management. (© 2026. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.) |
| Competing Interests: | Declarations. Disclosures: Zi-Han Geng, Xin-Yang Liu, Zhen Zhang, Min-Yue Wan, Yan Zhu, Pei-Yao Fu, Yan-Fang Tan, Quan-Lin Li, and Ping-Hong Zhou have no conflicts of interest or financial ties to disclose. |
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| Grant Information: | 82170555 National Natural Science Foundation of China; 82270569 National Natural Science Foundation of China; 82200600 National Natural Science Foundation of China; 82370546 National Natural Science Foundation of China; 22XD1422400 Shanghai Academic/Technology Research Leader; 22SG06 Shuguang Program of Shanghai Education Development Foundation and Shanghai Municipal Education Commission; 20224Z0005 Rising Stars of Medical Talent; 2023M740675 74th General Support of China Postdoctoral Science Foundation; Outstanding Resident Clinical Postdoctoral Program of Zhongshan Hospital Affiliated to Fudan University |
| Contributed Indexing: | Keywords: Achalasia; Gas-related adverse events; Peroral endoscopic myotomy; Risk prediction model |
| Entry Date(s): | Date Created: 20260713 Date Completed: 20260917 Latest Revision: 20261008 |
| Update Code: | 20261008 |
| DOI: | 10.1007/s00464-026-12853-y |
| PMID: | 42443675 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1432-2218 |
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| DOI: | 10.1007/s00464-026-12853-y |