| Title: |
External validation and optimization of the Limoges score to improve the delayed bleeding risk prediction after colorectal endoscopic submucosal dissection: the Delayed Bleeding ESD (DEBE) score |
| Authors: |
Albéniz, Eduardo; Montori, Sheyla; Enguita-Germán, Mónica; Marín-Gabriel, José C.; Herreros de Tejada, Alberto; Wallenhorst, Timothée; Rivory, Jérôme; Legros, Romain; Degand, Thibault; Chevaux, Jean-Baptiste; Ramos-Zabala, Felipe; Le Baleur, Yann; Rostain, Florian; Berger, Arthur; Rosón, Pedro J.; Terán, Álvaro; Barret, Maximilien; Leclercq, Philipe; Chabrun, Edouard; Schaeffer, Marion; Brieau, Bertrand; Boukechiche, Safia; Hijos-Mallada, Gonzalo; Pioche, Mathieu; Jacques, Jérémie |
| Source: |
Endoscopy ; ISSN 0013-726X 1438-8812 |
| Publisher Information: |
Georg Thieme Verlag KG |
| Publication Year: |
2026 |
| Description: |
Background The Limoges Bleeding Score estimates an individual’s risk of clinically significant delayed bleeding (CSDB) after colorectal endoscopic submucosal dissection (ESD). We aimed to validate and update this model in a Western setting. Methods Procedural data and complications were prospectively recorded in French–Belgian (FECCO) and Spanish cohorts. The Limoges score was externally validated. A revised Western score was derived. Score performance was determined by discrimination and calibration. Internal validation was performed using bootstrapping and leave-one-out cross-validation. The score’s performance was independently assessed in both cohorts. Results 4767 ESDs were included: 33.7 % rectal and 37.7 % proximal; median lesion size 50 mm; mean patient age 68.1 years; American Society of Anesthesiologists (ASA) score I–II 72.9 %; anticoagulants 10.9 %, and antiplatelets 17.0 %. CSDB prevalence was 6.8 %. The performance of the Limoges score was modest. A new score called DEBE (Delayed Bleeding ESD) was developed: age ≥ 75 years (2 points), lesion size ≥ 50 mm (5 points), ASA classification III–IV (4 points), location in the rectum (2 points) or proximal colon (1 point), anticoagulants (7 points) and antiplatelets (3 points). The DEBE score ranged from 0 to 23 points and categorized the patients into two groups (low risk 3.9 %; medium-high risk 14.2 %). The score showed acceptable discrimination (area under the curve 0.712), adequate calibration, and consistent performance after internal validation. Conclusions The DEBE score, based on seven preprocedural variables, allowed a personalized assessment of bleeding risk. It determined the individual CSDB risk, identified patients who would benefit from prophylactic treatment, and defined those who require monitoring after ESD. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1055/a-2814-4950 |
| DOI: |
10.1055/a-2814-4950.pdf |
| Availability: |
https://doi.org/10.1055/a-2814-4950; http://www.thieme-connect.de/products/ejournals/pdf/10.1055/a-2814-4950.pdf |
| Rights: |
https://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.7B21FB53 |
| Database: |
BASE |