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

Waku Hatta, Yosuke Tsuji, Toshiyuki Yoshio, Naomi Kakushima, Shu Hoteya, Hisashi Doyama, Yasuaki Nagami, Takuto Hikichi, Masakuni Kobayashi, Yoshinori Morita, Tetsuya Sumiyoshi, Mikitaka Iguchi, Hideomi Tomida, Takuya Inoue, Tomoyuki Koike, Tatsuya Mikami, Kenkei Hasatani, Jun Nishikawa, Tomoaki Matsumura, Hiroko NebikiDai Nakamatsu, Ken Ohnita, Haruhisa Suzuki, Hiroya Ueyama, Yoshito Hayashi, Mitsushige Sugimoto, Shinjiro Yamaguchi, Tomoki Michida, Tomoyuki Yada, Yoshiro Asahina, Toshiaki Narasaka, Shiko Kuribasyashi, Shu Kiyotoki, Katsuhiro Mabe, Tomohiro Nakamura, Naoki Nakaya, Mitsuhiro Fujishiro, Atsushi Masamune

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)476-484
Number of pages9
JournalGut
Volume70
Issue number3
DOIs
Publication statusPublished - 2021 Mar 1

Keywords

  • bleeding
  • endoscopy
  • gastric cancer

ASJC Scopus subject areas

  • Gastroenterology

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