Validation of the BEST-J score and identification of bile reflux as a risk factor for delayed bleeding after gastric endoscopic submucosal dissection

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. 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. 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. 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.