Correlation between sarcopenia and esophageal stenosis following endoscopic submucosal dissection and construction of...

Sarcopenia has been indicated to be related to the postoperative outcome of patients with various digestive tract diseases. However, no studies have investigated the association between sarcopenia and esophageal stenosis after endoscopic submucosal dissection (ESD).

To explore the correlation between sarcopenia and post-ESD esophageal stenosis, and subsequently develop a risk prediction model.

Retrospective data from 499 patients who underwent esophageal ESD were collected. After stratification via the L3 skeletal muscle indices (L3-SMIs) into sarcopenia and non-sarcopenia groups, post-ESD stenosis rates were compared. Propensity score matching (PSM) was used for sensitivity analysis. The original cohort was randomly split at a ratio of 7:3 into training (n = 350) and validation (n = 149) groups to construct and validate a risk prediction model for post-ESD stenosis.

Sarcopenia was significantly associated with post-ESD esophageal stenosis (48.23% vs 22.35%, P < 0.001). Furthermore, multivariate analysis confirmed its independence as a predictor of this postoperative complication [odds ratio (OR): 3.86; 95% confidence interval: 1.76-8.45; P < 0.001]. This conclusion was consistent across the subgroup analyses and PSM analyses. The risk prediction model incorporating sarcopenia had area under the curve values of 0.848 (training set) and 0.794 (validation set). Calibration curves and Hosmer-Lemeshow tests indicated good calibration of the model. Moreover, decision curve analysis confirmed a positive net clinical benefit for the model.

Sarcopenia is an independent risk predictor of post-ESD esophageal stenosis. Our model integrating muscle mass assessment aids in early high-risk identification and intervention.