Gastroenterology Department, Hospital da Senhora da Oliveira, Rua dos Cutileiros, Creixomil, 4835-044, Guimarães, Portugal.
Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.
Dig Dis Sci. 2024 Apr;69(4):1372-1379. doi: 10.1007/s10620-024-08293-0. Epub 2024 Feb 14.
Delayed bleeding (DB) is a possible adverse event following gastric endoscopic submucosal dissection (ESD). The BEST-J score was created as a risk prediction model for DB following gastric ESD, but is yet to be validated in Western populations.
We aimed to validate the BEST-J score on a European sample and to perform a subgroup analysis according to histological classification.
Retrospective study of all consecutive patients undergoing gastric ESD on a European Endoscopic Unit. DB was defined as hemorrhage with clinical symptoms and confirmed by emergency endoscopy from the time of completion to 28 days after ESD. BEST-J score was calculated in each patient and confronted with the outcome (DB).
Final sample included 161 patients. From these, 10 (6.2%) presented DB following ESD, with a median time to bleeding of 7 days (IQR 6.8). BEST-J score presented an excellent accuracy predicting DB in our sample, with an AUC = 0.907 (95%CI 0.801-1.000; p < 0.001). Subgroup analysis by histological classification proved that the discriminative power was still excellent for each grade: low-grade dysplasia-AUC = 0.970 (p < 0.001); high-grade dysplasia-AUC = 0.874 (p < 0.001); early gastric cancer-AUC = 0.881 (p < 0.001). The optimal cut-off value to predict DB was a BEST-J score ≥ 3, which matches the cut-off value for high-risk of bleeding in the original investigation.
The BEST-J score still presents excellent accuracy in risk stratification for post-ESD bleeding in European individuals. Thus, this score may help to guide which patients benefit the most from prophylactic therapies following gastric ESD in this setting.
延迟性出血（DB）是胃内镜黏膜下剥离术（ESD）后的一种可能的不良事件。BEST-J 评分是一种预测胃 ESD 后 DB 的风险预测模型，但尚未在西方人群中得到验证。
我们旨在验证 BEST-J 评分在欧洲人群中的有效性，并根据组织学分类进行亚组分析。
对在欧洲内镜单位接受胃 ESD 的所有连续患者进行回顾性研究。DB 定义为 ESD 完成后至 ESD 后 28 天内出现临床症状并经紧急内镜证实的出血。在每个患者中计算 BEST-J 评分，并将其与结果（DB）进行比较。
最终样本包括 161 名患者。其中 10 名（6.2%）在 ESD 后出现 DB，中位出血时间为 7 天（IQR 6.8）。BEST-J 评分在我们的样本中预测 DB 的准确性非常高，AUC=0.907（95%CI 0.801-1.000；p<0.001）。按组织学分类的亚组分析证明，每个等级的判别能力仍然非常出色：低级别异型增生-AUC=0.970（p<0.001）；高级别异型增生-AUC=0.874（p<0.001）；早期胃癌-AUC=0.881（p<0.001）。预测 DB 的最佳截断值为 BEST-J 评分≥3，这与原始研究中高出血风险的截断值相匹配。
BEST-J 评分在欧洲人群中对 ESD 后出血的风险分层仍然具有很高的准确性。因此，该评分可能有助于指导在此背景下接受胃 ESD 的患者中哪些患者最受益于预防性治疗。
