Abstract：Objective To evaluate the prediction model of delayed bleeding after endoscopic submucosal dissection (ESD) for early gastric cancer and to develop a new model. Methods A retrospective analysis was conducted on clinical data of patients with early gastric cancer who received ESD treatment in Gastroenterology Department of the 910th Hospital of PLA Joint Logistics Support Force from January 2017 to December 2022. All patients were divided into delayed bleeding group and non-bleeding group according to whether bleeding occurrence. Univariate and multivariate logistic regression analysis were conducted on clinical data of the two groups to identify factors affecting delayed bleeding, and a new delayed bleeding prediction model was constructed. The predictive performance of the new model and the BEST-J score was evaluated using the receiver operating characteristic (ROC) curve. Results A total of 428 patients with early gastric cancer who received ESD were included, with 26 cases (6.07%) of delayed bleeding. Compared with the non-bleeding group, the delayed bleeding group had higher mean BEST-J score (P< 0.001) and higher proportion of high-risk and very high-risk patients (P=0.013). Multivariate logistic regression analysis showed that smoking history (OR=2.219, 95%CI: 1.068-4.610,P=0.040), tumor maximum diameter >20 mm (OR=2.563,95%CI:1.244-5.283,P=0.010), resection of multiple tumors (OR=3.179,95%CI:1.134-8.913,P=0.033), and prolonged APTT (OR=5.959,95%CI:1.867-19.015,P=0.002) were independent risk factors, while intraoperative use of hemostatic clips (OR=0.312,95%CI:0.118-0.826, P=0.021) was a protective factor. The risk prediction model for delayed bleeding was constructed as follows: Logit(P) =-3.867 +0.797×(smoking history)-1.165×(intraoperative use of hemostatic clips)+1.157×(resection of multiple tumors)+0.941×(tumor>20 mm)+1.785×(APTT prolongation). ROC curve analysis showed that the new prediction model based on influencing factors had a larger area under the curve (AUC) than the BEST-J score (0.622 vs 0.809, P< 0.001). Conclusions The new prediction model based on smoking history, tumor size >20 mm, intraoperative use of hemostatic clips, resection of multiple tumors, and APTT prolongation is more suitable for predicting the risk of bleeding after ESD surgery in Chinese patients with early gastric cancer than BEST-J score than BEST-J score.
吴雅鋆, 曾清芳, 连丽凤, 施亚珠, 黄永德. 早期胃癌内镜黏膜下剥离术术后迟发性出血的BEST-J评分验证及新模型开发[J]. 武警医学, 2024, 35(7): 572-577.
WU Yayun, ZENG Qingfang, LIAN Lifeng, SHI Yazhu, HUANG Yongde. Validation of BEST-J score and development of a new model for delayed bleeding after endoscopic submucosal dissection for early gastric cancer. Med. J. Chin. Peop. Armed Poli. Forc., 2024, 35(7): 572-577.
Esaki M, Ihara E, Gotoda T. Endoscopic instruments and techniques in endoscopic submucosal dissection for early gastric cancer[J].Expert Rev GastroenterolHepatol, 2021, 15(9):1009-1020.
Hatta W, Tsuji Y, Yoshio T, et al. Prediction model of bleeding after endoscopic submucosal dissection for early gastric cancer: BEST-J score[J].Gut, 2021, 70(3):476-484.
[7]
Kagawa Y, Fukuzawa M, Sugimoto M, et al. Validation of the BEST-J score, a prediction model for bleeding after endoscopic submucosal dissection for early gastric cancer: a multicenter retrospective observational study[J].Surg Endosc, 2022, 36(10):7240-7249.
Nagami Y, Hatta W, Tsuji Y, et al. Antithrombotics increase bleeding after endoscopic submucosal dissection for gastric cancer: Nationwide propensity score analysis[J]. Dig Endosc, 2022, 34(5):974-983.
[10]
Gao Y L, Zhang Y H, Cao M. Preoperative evaluation of endoscopic submucosal dissection for early gastric cancer[J].Medicine (Baltimore), 2022, 101(37):e30582.
[11]
Yabuuchi Y, Hatta W, Tsuji Y, et al. Influence of hospital volume on bleeding after endoscopic submucosal dissection for early gastric cancer in Japan: a multicenter propensity score-matched analysis[J]. Surg Endosc, 2022, 36(6):4004-4013.
[12]
Kato M, Uedo N, Hokimoto S, et al. Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment: 2017 appendix on anticoagulants including direct oral anticoagulants[J]. Dig Endosc, 2018, 30(4):433-440.
Nordestgaard A T, Rasmussen L S, Sillesen M, et al. Smoking and risk of surgical bleeding: nationwide analysis of 5, 452, 411 surgical cases[J].Transfusion,2020, 60(8):1689-1699.
[15]
Ohlrogge A H, Frost L, Schnabel R B. Harmful impact of tobacco smoking and alcohol consumption on the atrial myocardium[J]. Cells, 2022, 11(16):2576.
Azumi M, Takeuchi M, Koseki Y, et al. The search, coagulation, and clipping (SCC) method prevents delayed bleeding after gastric endoscopic submucosal dissection [J].Gastric Cancer, 2019, 22(3):567-575.
2024, Vol. 35 
