On the basis of a comprehensive literature review, including a prior systematic review,20 (
link) and clinical relevance, we identified that the following variables were potentially associated with bleeding after ESD: sex, comorbidities (ischaemic heart disease, liver cirrhosis and chronic kidney disease (CKD) with haemodialysis), AT therapy (aspirin, P2Y12RA, cilostazol, warfarin and DOAC), the tumour characteristics (multiple tumours, lower-third in tumour location, tumour size >30 mm, undifferentiated type, submucosal invasion ≥500 µm from the muscularis mucosa (SM2) and ulceration) and procedure (ESD procedure time >120 min and SLE). We also selected characteristics that may influence bleeding, including age (≥75 years), piecemeal resection and mild/no endoscopic gastric atrophy according to the Kimura and Takemoto classification.21 (
link) With regard to the AT agents, the variables for the interruption of AT agents, heparin bridging and replacement of APAs were included in the model because of their possible influence on bleeding.
Hatta W., Tsuji Y., Yoshio T., Kakushima N., Hoteya S., Doyama H., Nagami Y., Hikichi T., Kobayashi M., Morita Y., Sumiyoshi T., Iguchi M., Tomida H., Inoue T., Koike T., Mikami T., Hasatani K., Nishikawa J., Matsumura T., Nebiki H., Nakamatsu D., Ohnita K., Suzuki H., Ueyama H., Hayashi Y., Sugimoto M., Yamaguchi S., Michida T., Yada T., Asahina Y., Narasaka T., Kuribasyashi S., Kiyotoki S., Mabe K., Nakamura T., Nakaya N., Fujishiro M, & Masamune A. (2020). Prediction model of bleeding after endoscopic submucosal dissection for early gastric cancer: BEST-J score. Gut, 70(3), 476-484.