{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T15:16:53Z","timestamp":1787843813222,"version":"build-2784847793"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Early detection of gastric retention (GR) is challenging in clinical practice. We aimed to develop and validate interpretable machine learning (ML) models for predicting GR risk using routinely available clinical features.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective study enrolled 3,233 consecutive patients (training cohort:\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092,263; validation cohort:\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009970) who underwent gastroscopy between January 2022 and December 2024. To address class imbalance, the Synthetic Minority Over-sampling Technique (SMOTE) was applied prior to model development. Optimal features were selected via least absolute shrinkage and selection operator (LASSO) regression within the SMOTE-enhanced training cohort, with different predictive models constructed using nine machine learning (ML) algorithms. Ten-fold cross-validation on SMOTE-enhanced training cohort was used for hyperparameter tuning. Model performance was primarily assessed on the validation cohort using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis (DCA).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>LASSO regression identified 12 clinically actionable predictors from 19 candidate variables, which were subsequently used to develop nine ML models. Among these models, the extreme gradient boosting (XGBoost) model achieved the highest AUC value of 0.710 (95% CI: 0.681\u20130.738) in the validation cohort. Decision curve analysis revealed that the XGBoost model exhibited superior clinical utility compared to other models. Shapley Additive Explanations (SHAP) identified the use of anticholinergic drugs, pyloric obstruction, analgesic use, systemic diseases, and a history of gastrointestinal surgery as the top five important predictive features.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study establishes an interpretable GR risk stratification model using routinely available preoperative variables. The model may serve as an auxiliary screening aid for pre-gastroscopy risk assessment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1898316","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:16:50Z","timestamp":1787840210000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Interpretable and explainable predictive machine learning models for gastric retention before gastroscopy"],"prefix":"10.3389","volume":"13","author":[{"given":"Yun","family":"Dai","sequence":"first","affiliation":[{"name":"Department of Endoscopy, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University","place":["Xiamen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huan-Zhong","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University","place":["Xiamen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong-Bin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Endoscopy, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University","place":["Xiamen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin-Hai","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Endoscopy, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University","place":["Xiamen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guo-Xing","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Endoscopy, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University","place":["Xiamen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hai-Xing","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Endoscopy, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University","place":["Xiamen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2593","DOI":"10.1007\/s10620-016-4173-7","article-title":"Endoscopic gastric food retention in relation to scintigraphic gastric emptying delays and clinical factors","volume":"61","author":"Coleski","year":"2016","journal-title":"Dig Dis Sci"},{"key":"B2","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1007\/s10120-019-01037-4","article-title":"Risk factors and prognosis of gastric stasis, a crucial problem after laparoscopic pylorus-preserving gastrectomy for early middle-third gastric cancer","volume":"23","author":"Takahashi","year":"2020","journal-title":"Gastric Cancer"},{"key":"B3","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1159\/000529316","article-title":"Characteristics of gastric stasis due to deformation after endoscopic submucosal dissection in the lower part of the stomach","volume":"104","author":"Takayama","year":"2023","journal-title":"Digestion"},{"key":"B4","doi-asserted-by":"publisher","first-page":"3853","DOI":"10.1007\/s00464-019-07151-9","article-title":"Preventive effect on delayed gastric emptying of preserving the infra-pyloric vein in laparoscopic pylorus-preserving gastrectomy for early gastric cancer","volume":"34","author":"Kaji","year":"2020","journal-title":"Surg Endosc"},{"key":"B5","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1038\/nrgastro.2011.116","article-title":"Gastroparesis: pathogenesis, diagnosis and management","volume":"8","author":"Hasler","year":"2011","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1318","DOI":"10.1210\/er.2018-00161","article-title":"Diabetic gastroparesis","volume":"40","author":"Bharucha","year":"2019","journal-title":"Endocr Rev"},{"key":"B7","doi-asserted-by":"publisher","first-page":"13690","DOI":"10.1038\/s41598-025-94378-3","article-title":"A comparative study on TB incidence and HIVTB coinfection using machine learning models on WHO global TB dataset","volume":"15","author":"Emegano","year":"2025","journal-title":"Sci Rep"},{"key":"B8","doi-asserted-by":"publisher","first-page":"2525","DOI":"10.1021\/acs.analchem.8b05497","article-title":"Detection of extended-Spectrum \u03b2-lactamase-producing Escherichia coli using infrared microscopy and machine-learning algorithms","volume":"91","author":"Sharaha","year":"2019","journal-title":"Anal Chem"},{"key":"B9","doi-asserted-by":"publisher","first-page":"16440","DOI":"10.1038\/s41598-025-00024-3","article-title":"A deep learning and molecular modeling approach to repurposing cangrelor as a potential inhibitor of nipah virus","volume":"15","author":"John","year":"2025","journal-title":"Sci Rep"},{"key":"B10","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1186\/s12933-025-02611-0","article-title":"Predicting cardiovascular outcomes in Chinese patients with type 2 diabetes by combining risk factor trajectories and machine learning algorithm: a cohort study","volume":"24","author":"Huang","year":"2025","journal-title":"Cardiovasc Diabetol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"760","DOI":"10.1002\/psp4.12643","article-title":"An artificial neural network-pharmacokinetic model and its interpretation using shapley additive explanations","volume":"10","author":"Ogami","year":"2021","journal-title":"CPT Pharmacometrics Syst Pharmacol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1367340","DOI":"10.3389\/fimmu.2024.1367340","article-title":"Creating machine learning models that interpretably link systemic inflammatory index, sex steroid hormones, and dietary antioxidants to identify gout using the SHAP (SHapley additive exPlanations) method","volume":"15","author":"Cao","year":"2024","journal-title":"Front Immunol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1124232","DOI":"10.3389\/fnagi.2023.1124232","article-title":"Identifying key multi-modal predictors of incipient dementia in Parkinson\u2019s disease: a machine learning analysis and tree SHAP interpretation","volume":"15","author":"McFall","year":"2023","journal-title":"Front Aging Neurosci"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e26305","DOI":"10.2196\/26305","article-title":"Detecting Parkinson disease using a web-based speech task: observational study","volume":"23","author":"Rahman","year":"2021","journal-title":"J Med Internet Res"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1939","DOI":"10.1097\/JS9.0000000000002203","article-title":"Development and validation of an interpretable machine learning model to predict major adverse cardiovascular events after noncardiac surgery in geriatric patients: a prospective study","volume":"111","author":"Yu","year":"2025","journal-title":"Int J Surg"},{"key":"B16","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1136\/gut.2005.078634","article-title":"Functional dyspepsia, delayed gastric emptying, and impaired quality of life","volume":"55","author":"Talley","year":"2006","journal-title":"Gut"},{"key":"B17","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1613\/jair.953","article-title":"SMOTE: synthetic minority over-sampling technique","volume":"10","year":"2002","journal-title":"J Artif Intell Res."},{"key":"B18","doi-asserted-by":"publisher","first-page":"6292","DOI":"10.3748\/wjg.v19.i37.6292","article-title":"Video capsule endoscopy and CT enterography in diagnosing adult hypertrophic pyloric stenosis","volume":"19","author":"Gurvits","year":"2013","journal-title":"World J Gastroenterol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1159\/000445226","article-title":"Functional dyspepsia and gastroparesis","volume":"34","author":"Camilleri","year":"2016","journal-title":"Dig Dis"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1568","DOI":"10.1007\/s11605-022-05538-z","article-title":"Risk factor analysis of gastroparesis syndrome in 2652 patients with radical distal gastrectomy","volume":"27","author":"Yu","year":"2023","journal-title":"J Gastrointest Surg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1186\/1477-7819-11-144","article-title":"Incidence and risk factors for postsurgical gastroparesis syndrome after laparoscopic and open radical gastrectomy","volume":"11","author":"Meng","year":"2013","journal-title":"World J Surg Oncol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1016\/j.ejso.2012.12.010","article-title":"Clinical risk factors of delayed gastric emptying in patients after pancreaticoduodenectomy: a systematic review and meta-analysis","volume":"39","author":"Qu","year":"2013","journal-title":"Eur J Surg Oncol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"3622","DOI":"10.1007\/s00464-018-6091-6","article-title":"Endoscopic submucosal dissection for early gastric cancer on the lesser curvature in upper third of the stomach is a risk factor for postoperative delayed gastric emptying","volume":"32","author":"Yoshizaki","year":"2018","journal-title":"Surg Endosc"},{"key":"B24","doi-asserted-by":"publisher","first-page":"3561","DOI":"10.3168\/jds.2009-2968","article-title":"Potassium and insulin affect the contractility of abomasal smooth muscle","volume":"93","author":"T\u00fcrck","year":"2010","journal-title":"J Dairy Sci"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1017","DOI":"10.1016\/S2468-1253(20)30078-9","article-title":"Nutritional approaches for gastroparesis","volume":"5","author":"Limketkai","year":"2020","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1497","DOI":"10.1002\/oby.23204","article-title":"Association of gastric emptying with postprandial appetite and satiety sensations in obesity","volume":"29","author":"Gonzalez-Izundegui","year":"2021","journal-title":"Obesity (Silver Spring)"},{"key":"B27","doi-asserted-by":"publisher","first-page":"714","DOI":"10.1016\/j.soard.2012.03.008","article-title":"Gastric emptying is not prolonged in obese patients","author":"Buchholz","year":"2013","journal-title":"Surg Obes Relat Dis"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1768","DOI":"10.1016\/j.clinthera.2021.08.006","article-title":"Pooled analysis of gastric emptying in patients with obesity: implications for oral absorption projection","volume":"43","author":"Lu","year":"2021","journal-title":"Clin Ther"},{"key":"B29","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/j.cgh.2010.09.022","article-title":"Epidemiology, mechanisms, and management of diabetic gastroparesis","volume":"9","author":"Camilleri","year":"2011","journal-title":"Clin Gastroenterol Hepatol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1038\/ajg.2011.310","article-title":"Risk of gastroparesis in subjects with type 1 and 2 diabetes in the general population","volume":"107","author":"Choung","year":"2012","journal-title":"Am J Gastroenterol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1177\/0310057X1504300610","article-title":"High-risk residual gastric content in fasted patients undergoing gastrointestinal endoscopy: a prospective cohort study of prevalence and predictors","volume":"43","author":"Phillips","year":"2015","journal-title":"Anaesth Intensive Care"},{"key":"B32","doi-asserted-by":"publisher","first-page":"2574","DOI":"10.4240\/wjgs.v16.i8.2574","article-title":"Establishment of predictive models and determinants of preoperative gastric retention in endoscopic retrograde cholangiopancreatography","volume":"16","author":"Jia","year":"2024","journal-title":"World J Gastrointest Surg"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1898316\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:16:51Z","timestamp":1787840211000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1898316\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,27]]},"references-count":32,"alternative-id":["10.3389\/fmed.2026.1898316"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1898316","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,27]]},"article-number":"1898316"}}