Endoscopic sleeve gastroplasty scoring system predicts reintervention with 74% probability
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Key takeaways:
- Researchers developed an endoscopic sleeve gastroplasty scoring system that had a 74% probability of predicting reintervention within 30 days.
- Sensitivity and specificity was 0.76 and 0.71, respectively.
A novel scoring system could aid clinicians by predicting the risk for 30-day reintervention among patients who underwent endoscopic sleeve gastroplasty, according to data published in Gastrointestinal Endoscopy.
“Our team conducted this investigation to address the issue of additional procedures needed after endoscopic sleeve gastroplasty (ESG),” Hassam Ali, MD, a clinical fellow in gastroenterology and hepatology at East Carolina University, told Healio. “Sometimes, patients require further intervention due to complications before or after the ESG procedure. ESG is a relatively new procedure, and many physicians and patients are unfamiliar.
“To make well-informed decisions with patients, it would be helpful to have a model that can predict potential complications, such as the need for additional procedures, within the first 30 days after ESG.”
Using the Metabolic and Bariatric Surgery Accreditation Quality Improvement Program database, Ali and colleagues evaluated data from 3,583 patients (median age, 48 years; 85.5% men) who underwent ESG from 2016 to 2021. Researchers then used Least Absolute Shrinkage and Selection Operator penalized regression to identify predictive variables of 30-day reintervention and generate an ESG reintervention scoring system (ESGRS).
According to analysis, the 30-day endoscopic reintervention rate for ESG was 3.3%.
Of 11 variables selected, researchers determined that five factors — history of foregut surgery (OR = 4.98; 95% CI, 3.08-8.06), preoperative anticoagulation use (OR = 2.22; 95% CI, 1.1-4.51), female sex (OR = 0.44; 95% CI, 0.29-0.68), American Society of Anesthesiologists Classification score of 2 or greater (OR = 1.62; 95% CI, 1.03-2.52) and hypertension (OR = 1.63; 95% CI, 1.11-2.4) — were “significant” predictors of reintervention.
“These factors can increase the risk of needing additional procedures, except for being female, which is associated with lower risk,” Ali said.
Internal validation of the ESGRS generated an area under the curve of 0.74 (95% CI, 0.7-0.78), which equated to a 74% probability of the model predicting ESG reintervention within 30 days. An optimal cut point of 67.9 also was identified using the Youden index, with a sensitivity and specificity was 0.76 and 0.71, respectively.
Researchers noted that an ESGRS of at least 67.9 had a 76.1% (95% CI, 74.7-77.5) positive predictive value and an ESGRS of less than 67.9 had a 61% (95% CI, 59-62.4) negative predictive value.
“These results provide valuable guidance for clinicians in assessing the risk of needing additional procedures before performing ESG on a patient,” Ali said. “By considering the factors included in the ESGRS, health care providers can better manage patients and potentially reduce the risk of reintervention.”
He continued: “Further research could focus on validating the ESGRS in different patient populations and clinical settings to ensure its accuracy and applicability. Additionally, efforts can be made to refine and improve the predictive accuracy of the ESGRS model.”
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