A preoperative scoring model to predict intraoperative high end-tidal carbon dioxide in endoscopic resection of gastric submucosal tumors
7 affiliations
- 1Department of Gastroenterology, Suzhou BenQ Medical Center
- 2Department of Endoscopy Center, The First People’s Hospital of Kunshan
- 3Department of Gastroenterology, The Affiliated Zhangjiagang Hospital of Soochow University
- 4Department of Gastroenterology, The First Affiliated Hospital of Soochow University
- 5Department of Gastroenterology, Nanjing First Hospital, Nanjing Medical University
- 6Department of Anesthesiology, Changshu Hospital Affiliated to Soochow University
- 7Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University
Abstract
Intraoperative high end-tidal carbon dioxide (ETCO₂) during endoscopic resection (ER) of gastric submucosal tumors (SMTs) may cause respiratory compromise. Preoperative identification of risk factors and development of a scoring model to predict intraoperative high ETCO₂ may aid in preoperative planning. A total of 1,368 patients were retrospectively enrolled and divided into a training cohort (TC, n = 690), an internal validation cohort (IVC, n = 296), and an external validation cohort (EVC, n = 382). Preoperative variables were compared between the high ETCO₂ and normal groups in the TC. Multivariate logistic regression was performed to identify independent risk factors for intraoperative high ETCO₂ and to construct a simplified scoring system. The model’s performance was assessed using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy in the TC, IVC, and EVC. Intraoperative high ETCO₂ was documented in 341 (24.9%) patients. Multivariate analysis identified age ≥ 65 years (1 point), BMI ≥ 24.0 kg/m² (1 point), tumor size ≥ 3.0 cm (1 point), and invasion depth beyond muscularis propria (2 points) as independent predictors, which were incorporated to build a weighted scoring model. The model showed good discrimination, with AUCs of 0.832 (IVC) and 0.807 (EVC) and high NPVs of 90.0% and 88.7%. The incidence of intraoperative high ETCO₂ increased significantly with risk stratification: low-risk (score 0–1), intermediate-risk (score 2–3), and high-risk (score 4–5) groups exhibited rates of 11.0%, 52.7%, 85.7% (TC); 10.0%, 42.1%, 89.5% (IVC); and 11.3%, 39.3%, 85.7% (EVC), respectively. This preoperative scoring model based on four readily available clinical variables shows good discrimination for predicting intraoperative high ETCO₂. It may help raise preoperative awareness and guide the intensity of intraoperative monitoring. However, prospective validation is required before clinical implementation.
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BibTeX
@article{zang2026preoperative,
title = {{A preoperative scoring model to predict intraoperative high end-tidal carbon dioxide in endoscopic resection of gastric submucosal tumors}},
author = {Fengcheng Zang and Qian Zhang and Yunfu Feng and Jie Xu and Chao Ma and Zhibing Wang and Lin Xu and Luojie Liu and Xiaodan Xu and Gongyu Zhang},
journal = {Scientific Reports},
year = {2026},
month = jul,
doi = {10.1038/s41598-026-64359-1},
url = {https://doi.org/10.1038/s41598-026-64359-1},
note = {CC BY},
}
RIS
TY - JOUR
TI - A preoperative scoring model to predict intraoperative high end-tidal carbon dioxide in endoscopic resection of gastric submucosal tumors
AU - Fengcheng Zang
AU - Qian Zhang
AU - Yunfu Feng
AU - Jie Xu
AU - Chao Ma
AU - Zhibing Wang
AU - Lin Xu
AU - Luojie Liu
AU - Xiaodan Xu
AU - Gongyu Zhang
PY - 2026
DA - 2026/07/01
JO - Scientific Reports
DO - 10.1038/s41598-026-64359-1
UR - https://doi.org/10.1038/s41598-026-64359-1
AB - Intraoperative high end-tidal carbon dioxide (ETCO₂) during endoscopic resection (ER) of gastric submucosal tumors (SMTs) may cause respiratory compromise. Preoperative identification of risk factors and development of a scoring model to predict intraoperative high ETCO₂ may aid in preoperative planning. A total of 1,368 patients were retrospectively enrolled and divided into a training cohort (TC, n = 690), an internal validation cohort (IVC, n = 296), and an external validation cohort (EVC, n = 382). Preoperative variables were compared between the high ETCO₂ and normal groups in the TC. Multivariate logistic regression was performed to identify independent risk factors for intraoperative high ETCO₂ and to construct a simplified scoring system. The model’s performance was assessed using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy in the TC, IVC, and EVC. Intraoperative high ETCO₂ was documented in 341 (24.9%) patients. Multivariate analysis identified age ≥ 65 years (1 point), BMI ≥ 24.0 kg/m² (1 point), tumor size ≥ 3.0 cm (1 point), and invasion depth beyond muscularis propria (2 points) as independent predictors, which were incorporated to build a weighted scoring model. The model showed good discrimination, with AUCs of 0.832 (IVC) and 0.807 (EVC) and high NPVs of 90.0% and 88.7%. The incidence of intraoperative high ETCO₂ increased significantly with risk stratification: low-risk (score 0–1), intermediate-risk (score 2–3), and high-risk (score 4–5) groups exhibited rates of 11.0%, 52.7%, 85.7% (TC); 10.0%, 42.1%, 89.5% (IVC); and 11.3%, 39.3%, 85.7% (EVC), respectively. This preoperative scoring model based on four readily available clinical variables shows good discrimination for predicting intraoperative high ETCO₂. It may help raise preoperative awareness and guide the intensity of intraoperative monitoring. However, prospective validation is required before clinical implementation.
SN - 2045-2322
ER -