Bleeding after ESD occurs in 4.1%–8.5% of patients who undergo gastric ESD. The "BEST-J score" is a prediction model to stratify the risk of bleeding after ESD for early gastric cancers. Nine factors were weighted with point values: 4 points for anticoagulants (warfarin, direct oral anticoagulants), 3 points for chronic kidney disease with hemodialysis, 2 points each for P2Y12 receptor antagonist (thienopyridine) and aspirin, 1 point each for cilostazol, a tumor size >30 mm, lower-third in tumor location, and presence of multiple tumors, and −1 point for interruption of each kind of antithrombotic agents. The patients were categorized into four bleeding risk groups: low (0–1 points: 2.8% risk), intermediate (2 points: 6.1%), high (3–4 points: 11.4%) and very high (≥5 points: 29.7%).
*1. If an antiplatelet agent was replaced with another agent, select "Temporal discontinuation" of the original agent and "None" of the replaced agent. For example, if P2Y12 receptor antagonist is replaced with aspirin, select "Temporal discontinuation" of P2Y12 receptor antagonist and "None" of aspirin.
*2. If the patient received heparin bridging therapy, select "Temporal discontinuation" of the original agent. For example, if warfarin is bridged with heparin, select "Temporal discontinuation" of warfarin.
*3. Time of discontinuing antithrombotic agents before ESD is based on the Japanese guidelines (Dig Endosc. 2014; 26: 1-14.): aspirin, 3−5 days; P2Y12 receptor antagonist (thienopyridine), 5−7 days; cilostazol, 1 day; warfarin, 3−5 days; DOAC, 1−2 days.
For more information, see the reference below.
Gut. 2020 [Epub ahead of print]
A prediction model of bleeding after endoscopic submucosal dissection for early gastric cancer: BEST-J score.
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, Kuribayashi S, Kiyotoki S, Mabe K, Nakamura T, Nakaya N, Fujishiro M, Masamune A.
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DISCLAIMER: This application is intended for educational or research purposes only. It does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.
[Developer]
2020 東北大学病院消化器内科・大腸グループ
2020 Kenichi Negoro, MD, PhD
2020 Yoichi Kakuta, MD, PhD
2020 Waku Hatta, MD, PhD (Consultant)
2020 Xiaoyi Jin, MD, PhD (Translation)
http://www.gastroente.med.tohoku.ac.jp/
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