ADVANCES IN MANAGING BLEEDING COMPLICATIONS IN GASTRIC TUMOR ESD: THE BEST-J SCORE AND FUTURE CHALLENGES

Abstract

With the increasing number of treatments available for ESD in gastric tumors, the effective management of associated complications has gained increasing importance. Among these complications, bleeding complications are frequent and potentially severe; thus, it is necessary to develop preventive measures. Notably, Hatta et al. developed the BEST-J score, a predictive model designed to anticipate post-ESD ulcer bleeding for early gastric cancer. This score incorporated ten factors (hemodialysis, aspirin, thienopyridine antiplatelets, cilostazol, warfarin, direct oral anticoagulant (DOAC), discontinuation of antithrombotic drugs, presence of multiple tumors, tumor diameter ≥30 mm, lower stomach) to assess bleeding risk, enabling risk stratification based on the total score. Despite the advances, the challenge of implementing individualized treatment for patients with high bleeding risk remains a concern. Future studies must focus on developing endoscopic treatment and addressing patients using anticoagulants, which poses the highest risk of bleeding among all the risk factors.