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. 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 (p = 0.012) and bile reflux (p = 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.