Liu SN, Chen Z. Clinical value of predicting bleeding after endoscopic submucosal dissection for early esophageal cancer. World J Gastrointest Surg 2025; 17(11): 111619 [DOI: 10.4240/wjgs.v17.i11.111619]
Corresponding Author of This Article
Zhuo Chen, Associate Chief Physician, Department of Gastroenterology, The First People's Hospital of Xuzhou, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University, No. 269 Daxue Road, Tongshan District, Xuzhou 221000, Jiangsu Province, China. winter_zhuo@163.com
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Gastroenterology & Hepatology
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Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 27, 2025 (publication date) through Nov 25, 2025
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World Journal of Gastrointestinal Surgery
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1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Liu SN, Chen Z. Clinical value of predicting bleeding after endoscopic submucosal dissection for early esophageal cancer. World J Gastrointest Surg 2025; 17(11): 111619 [DOI: 10.4240/wjgs.v17.i11.111619]
World J Gastrointest Surg. Nov 27, 2025; 17(11): 111619 Published online Nov 27, 2025. doi: 10.4240/wjgs.v17.i11.111619
Clinical value of predicting bleeding after endoscopic submucosal dissection for early esophageal cancer
Sheng-Nan Liu, Zhuo Chen
Sheng-Nan Liu, Department of Gastroenterology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, Jiangsu Province, China
Zhuo Chen, Department of Gastroenterology, The First People's Hospital of Xuzhou, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
Author contributions: Li SN organized the raw data, performed the statistical analysis, and drafted the manuscript; Chen Z conceived and oversaw the overall study design; both authors approved the final version of the manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of the Affiliated Hospital of Xuzhou Medical University (Approval No. XYFY2024-KL585-01).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: The data used in this study can be obtained from the corresponding author upon request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhuo Chen, Associate Chief Physician, Department of Gastroenterology, The First People's Hospital of Xuzhou, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University, No. 269 Daxue Road, Tongshan District, Xuzhou 221000, Jiangsu Province, China. winter_zhuo@163.com
Received: August 6, 2025 Revised: September 8, 2025 Accepted: September 28, 2025 Published online: November 27, 2025 Processing time: 110 Days and 19.9 Hours
Abstract
BACKGROUND
The incidence of esophageal cancer is high, and its prognosis is poor. Endoscopic submucosal dissection (ESD) is an important, minimally invasive treatment for early esophageal cancer, but the risk of postoperative bleeding affects its efficacy.
AIM
To explore risk factors of bleeding after ESD and evaluate the predictive value of a gradient boosting machine (GBM) model for postoperative bleeding.
METHODS
The clinical data of 178 early esophageal cancer patients who underwent ESD at the Affiliated Hospital of Xuzhou Medical University from October 2019 to October 2024 were analyzed retrospectively. Patients were divided into two groups (bleeding and non-bleeding). Univariate and multivariate logistic regression analyses identified risk factors for postoperative bleeding, leading to the construction of the GBM prediction model. The receiver operating characteristic (ROC) curve evaluated the predictive efficacy of the GBM model and bleeding after ESD trend from Japan (BEST-J) score.
RESULTS
Among 178 patients who received ESD treatment, 29 cases (16.29%) had bleeding, and 149 cases (83.71%) had no bleeding. The average BEST-J score and the proportion of high-risk and extremely high-risk patients were higher in the bleeding group than in the non-bleeding group (P < 0.05). Multivariate logistic regression analysis showed that tumor size ≥ 3 cm, surgical bleeding, and C-reactive protein (CRP) were independent risk factors for bleeding after ESD in patients with early esophageal cancer (P < 0.05). The ROC curve showed that the area under the curve of the GBM prediction model based on the influencing factors was greater than that of the BEST-J score (0.818 vs 0.653, P < 0.05).
CONCLUSION
The GBM prediction model based on tumor size ≥ 3 cm, surgical bleeding, and high CRP levels is more effective than the BEST-J score at predicting bleeding after ESD.
Core Tip: Although endoscopic submucosal dissection for early esophageal cancer is minimally invasive, postoperative bleeding affects its efficacy and prognosis. Investigating its risk factors and constructing a predictive model could help clinicians accurately assess the risk of bleeding, formulate personalized plans, reduce the occurrence of postoperative bleeding, and improve the safety of treatment and patient prognosis.
