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Multicenter Study
. 2021 Mar;70(3):476-484.
doi: 10.1136/gutjnl-2019-319926. Epub 2020 Jun 4.

Prediction model of bleeding after endoscopic submucosal dissection for early gastric cancer: BEST-J score

Waku Hatta  1 , Yosuke Tsuji  2 , Toshiyuki Yoshio  3 , Naomi Kakushima  4 , Shu Hoteya  5 , Hisashi Doyama  6 , Yasuaki Nagami  7 , Takuto Hikichi  8 , Masakuni Kobayashi  9 , Yoshinori Morita  10 , Tetsuya Sumiyoshi  11 , Mikitaka Iguchi  12 , Hideomi Tomida  13 , Takuya Inoue  14 , Tomoyuki Koike  1 , Tatsuya Mikami  15 , Kenkei Hasatani  16 , Jun Nishikawa  17 , Tomoaki Matsumura  18 , Hiroko Nebiki  19 , Dai Nakamatsu  20 , Ken Ohnita  21 , Haruhisa Suzuki  22 , Hiroya Ueyama  23 , Yoshito Hayashi  24 , Mitsushige Sugimoto  25   26 , Shinjiro Yamaguchi  27 , Tomoki Michida  28 , Tomoyuki Yada  29 , Yoshiro Asahina  30 , Toshiaki Narasaka  31 , Shiko Kuribasyashi  32 , Shu Kiyotoki  33 , Katsuhiro Mabe  34 , Tomohiro Nakamura  35 , Naoki Nakaya  36 , Mitsuhiro Fujishiro  37 , Atsushi Masamune  1
Affiliations
Multicenter Study

Prediction model of bleeding after endoscopic submucosal dissection for early gastric cancer: BEST-J score

Waku Hatta et al. Gut. 2021 Mar.

Abstract

Objective: Bleeding after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) is a frequent adverse event after ESD. We aimed to develop and externally validate a clinically useful prediction model (BEST-J score: Bleeding after ESD Trend from Japan) for bleeding after ESD for EGC.

Design: This retrospective study enrolled patients who underwent ESD for EGC. Patients in the derivation cohort (n=8291) were recruited from 25 institutions, and patients in the external validation cohort (n=2029) were recruited from eight institutions in other areas. In the derivation cohort, weighted points were assigned to predictors of bleeding determined in the multivariate logistic regression analysis and a prediction model was established. External validation of the model was conducted to analyse discrimination and calibration.

Results: A prediction model comprised 10 variables (warfarin, direct oral anticoagulant, chronic kidney disease with haemodialysis, P2Y12 receptor antagonist, aspirin, cilostazol, tumour size >30 mm, lower-third in tumour location, presence of multiple tumours and interruption of each kind of antithrombotic agents). The rates of bleeding after ESD at low-risk (0 to 1 points), intermediate-risk (2 points), high-risk (3 to 4 points) and very high-risk (≥5 points) were 2.8%, 6.1%, 11.4% and 29.7%, respectively. In the external validation cohort, the model showed moderately good discrimination, with a c-statistic of 0.70 (95% CI, 0.64 to 0.76), and good calibration (calibration-in-the-large, 0.05; calibration slope, 1.01).

Conclusions: In this nationwide multicentre study, we derived and externally validated a prediction model for bleeding after ESD. This model may be a good clinical decision-making support tool for ESD in patients with EGC.

Keywords: bleeding; endoscopy; gastric cancer.

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Conflict of interest statement

Competing interests: MF declared that he received lecture honoraria from Takeda Pharmaceutical, EA Pharma, Nihon Pharmaceutical and his department received research grants from HOYA Pentax, EA Pharma, Eisai, Taiho Phamaceutical, AbbVie GK, Nippon Kayaku, Chugai Pharmaceutical, Gilead Sciences, Kyorin Pharmaceutical, Mitsubishi Tanabe Pharma outside the submitted work.

Figures

Figure 1
Figure 1
The flowchart of patient enrolment for the derivation and validation cohorts. (A) Derivation cohort. (B) Validation cohort. ESD, endoscopic submucosal dissection; EGC, early gastric cancer.
See this image and copyright information in PMC

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