Modified BEST-J Score Model Predicts Bleeding after Endoscopic Submucosal Dissection with Fewer Factors

• Published in: Cancers Vol. 14; no. 22; p. 5555
• Main Authors: Okada, Tomoyuki, Mikamo, Tsuyoshi, Hamamoto, Wataru, Iwamoto, Taku, Okamoto, Toshiaki, Maeda, Kazunori, Yanagitani, Atsushi, Tanaka, Kiwamu, Isomoto, Hajime, Yamaguchi, Naoyuki
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01.11.2022; MDPI
• Subjects: Anticoagulants; BEST-J score; Bleeding; Blood; Blood vessels; Cancer; Comorbidity; Complications and side effects; Dissection; early gastric cancer; Endoscopy; gastric endoscopic submucosal dissection; Hemodialysis; Hemoglobin; Hemorrhage; Methods; Multivariate analysis; postoperative bleeding; Prediction models; prognostic nutritional index; Regression analysis; Risk factors; Stomach; Surgical outcomes; Tumors; Variables; Japan; prognostic nutritional index; postoperative bleeding; BEST-J score; gastric endoscopic submucosal dissection; early gastric cancer
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers14225555

This study constructed a simplified post-endoscopic submucosal dissection (ESD) prediction model with a prognostic nutritional index (PNI). A total of 449 patients who underwent gastric ESD was included, divided with a ratio of 2:1, and assigned to the model or validation cohort. A prediction model of post-ESD (modified BEST-J score) was constructed using the model cohort. The modified BEST-J score was evaluated by comparing its accuracy to the BEST-J score in the validation cohort. Within 4 weeks of ESD, melena, hematemesis, or a 2 g/dL or greater decrease in hemoglobin level that required esophagogastroduodenoscopy was defined as post-ESD bleeding. In the model cohort, 299 patients were enrolled and 25 (8.4%) had post-ESD bleeding. Independent risk factors for post-ESD bleeding were use of P2Y12RA, tumor size > 30 mm, location of lesion at lower one-third of the stomach, and PNI ≤ 47.9. Constructing the modified BEST-J score based on these variables, the sensitivity, specificity, and positive likelihood ratio were 73.9%, 78.1%, and 3.37. When comparing the modified BEST-J score to the BEST-J score in the validation cohort, no significant difference was observed by ROC-AUC (0.77 vs. 0.75, p = 0.81). Modified BEST-J score can predict post-ESD bleeding more simply, with the same accuracy as the BEST-J score.