Validation of the BEST-J score and identification of bile reflux as a risk factor for delayed bleeding after gastric endoscopic submucosal dissection.
[BACKGROUND] Gastric cancer (GC) is a leading cause of cancer-related morbidity and mortality globally.
APA
Zou L, Yang Y, et al. (2026). Validation of the BEST-J score and identification of bile reflux as a risk factor for delayed bleeding after gastric endoscopic submucosal dissection.. BMC gastroenterology, 26(1), 95. https://doi.org/10.1186/s12876-025-04575-7
MLA
Zou L, et al.. "Validation of the BEST-J score and identification of bile reflux as a risk factor for delayed bleeding after gastric endoscopic submucosal dissection.." BMC gastroenterology, vol. 26, no. 1, 2026, pp. 95.
PMID
41492063
Abstract
[BACKGROUND] Gastric cancer (GC) is a leading cause of cancer-related morbidity and mortality globally. Endoscopic submucosal dissection (ESD) has improved survival rates for early gastric cancer (EGC), but complications such as delayed bleeding remain a concern. This multicenter retrospective study aimed to validate the BEST-J prediction model for post-ESD bleeding in two Beijing hospitals and identify additional risk factors influencing this complication.
[METHODS] We analyzed data from 688 patients who underwent ESD for EGC across two institutions. Patient demographics, procedural details, and comorbidities were collected. The BEST-J score was calculated for each patient, and Firth’s penalized logistic regression was performed to identify independent risk factors for delayed bleeding.
[RESULTS] Our findings revealed that the BEST-J score had limited discriminative power in predicting post-ESD bleeding (AUC = 0.583). However, two independent risk factors—previous cerebral infarction ( = 0.012) and bile reflux ( = 0.012)—were significantly associated with delayed bleeding.
[CONCLUSION] This study underscores the necessity for ongoing validation of predictive models such as BEST-J, particularly across different populations. The identification of cerebral infarction and bile reflux as significant predictors highlights the need to integrate additional factors into risk assessments.
[SUPPLEMENTARY INFORMATION] The online version contains supplementary material available at 10.1186/s12876-025-04575-7.
[METHODS] We analyzed data from 688 patients who underwent ESD for EGC across two institutions. Patient demographics, procedural details, and comorbidities were collected. The BEST-J score was calculated for each patient, and Firth’s penalized logistic regression was performed to identify independent risk factors for delayed bleeding.
[RESULTS] Our findings revealed that the BEST-J score had limited discriminative power in predicting post-ESD bleeding (AUC = 0.583). However, two independent risk factors—previous cerebral infarction ( = 0.012) and bile reflux ( = 0.012)—were significantly associated with delayed bleeding.
[CONCLUSION] This study underscores the necessity for ongoing validation of predictive models such as BEST-J, particularly across different populations. The identification of cerebral infarction and bile reflux as significant predictors highlights the need to integrate additional factors into risk assessments.
[SUPPLEMENTARY INFORMATION] The online version contains supplementary material available at 10.1186/s12876-025-04575-7.
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