Validation of the BEST-J score, a prediction model for bleeding after endoscopic submucosal dissection for early gastric cancer: a multicenter retrospective observational study

• Published in: Surgical endoscopy Vol. 36; no. 10; pp. 7240 - 7249
• Main Authors: Kagawa, Yasuyuki, Fukuzawa, Masakatsu, Sugimoto, Mitsushige, Nemoto, Daiki, Muramatsu, Takahiro, Shinohara, Hirokazu, Matsumoto, Taisuke, Madarame, Akira, Yamaguchi, Hayato, Uchida, Kumiko, Morise, Takashi, Koyama, Yohei, Sugimoto, Akihiko, Yamauchi, Yoshiya, Kono, Shin, Naito, Sakiko, Yamamoto, Kei, Kishimoto, Yoshiko, Inuyama, Mitsuko, Kawai, Takashi, Itoi, Takao
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.10.2022; Springer Nature B.V
• Subjects: Abdominal Surgery; Anticoagulants; Anticoagulants - therapeutic use; Endoscopic Mucosal Resection - adverse effects; Endoscopy; Gastric cancer; Gastric Mucosa - pathology; Gastroenterology; Gynecology; Hepatology; Humans; Medicine; Medicine & Public Health; Multivariate analysis; Observational studies; Postoperative Hemorrhage - chemically induced; Postoperative Hemorrhage - etiology; Proctology; Purinergic P2Y Receptor Antagonists; Retrospective Studies; Risk Factors; Stomach Neoplasms - complications; Surgery; Warfarin - adverse effects; Early-stage gastric cancer; Endoscopic submucosal dissection; Bleeding
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-022-09096-y

Background A new scoring system, the BEST-J score, using ten risk factors to assign cases to different post-endoscopic submucosal dissection (ESD) risk groups for bleeding, has been shown to be accurate for risk stratification. We first aimed to validate the BEST-J score at four hospitals not specialized in performing ESD and then aimed to identify other risk factors for post-ESD bleeding. Methods We evaluated the incidence of post-ESD bleeding in 791 cases of early gastric cancer (EGC) between October 2013 and December 2020 as a retrospective, multi-center observational study conducted at four hospitals. Multivariate logistic regression models to examine the effect of independent variables on post-ESD bleeding firstly included ten possible factors raised by the BEST-J score and secondly included statistically significant ( p  < 0.01) in univariate analysis. The prediction accuracy of the model was evaluated by receiver-operating characteristic analysis and the areas under the curve (AUC). Results The incidence of post-ESD bleeding was 4.8% (38/791, 95% confidence interval [CI] 3.4–6.5%). On multivariate analysis, the risk factors were P2Y12 receptor antagonist (odds ratio [OR]: 5.870, 95% CI 1.624–21.219), warfarin (8.382, 1.658–42.322), direct oral anticoagulant (DOAC) (8.980, 1.603–50.322), and tumor location in lower third of stomach (2.151, 1.012–4.571), respectively. When we categorized cases into low-risk by BEST-J score, intermediate-risk, high-risk, and very high-risk groups, the bleeding rates were 2.8%, 7.3%, 12.8%, and 19.0%, respectively. The AUC for our cohort was 0.713 (95% CI 0.625–0.802) for the BEST-J score. In the multivariate analysis in our cohort, the risks were age, body mass index, P2Y12 receptor antagonist, warfarin, DOAC, respectively. Discussion The BEST-J score is equally accurate in risk stratification of patients with EGC for post-ESD bleeding at non-specialized facilities for ESD as in specialized hospitals. BMI and age may be helpful additional risk factors at hospitals not specialized.