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
Year: 2026
Type: article
Study design: Observational Study
Abstract: 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.
Source: Endoscopy
DOI: 10.1055/a-2814-4950
Authors: Eduardo Albéniz, Sheyla Montori, Mónica Enguita-Germán, José C. Marín-Gabriel, Alberto Herreros de Tejada, Timothée Wallenhorst, Jérôme Rivory, Romain Legros, Thibault Degand, Jean-Baptiste Chevaux, Felipe Ramos-Zabala, Yann Le Baleur, Florian Rostain, Arthur Berger, Pedro J. Rosón, Álvaro Terán, Maximilien Barret, Philipe Leclercq, Edouard Chabrun, Marion Schaeffer, Bertrand Brieau, Safia Boukechiche, Gonzalo Hijos-Mallada, Mathieu Pioche, Jérémie Jacques, on behalf of the Colorectal ESD Consortium Working Group
Institutions: Universidad Pública de Navarra (UPNA), Navarre Institute of Health Research, Navarrabiomed, Universidad Complutense de Madrid, Research Institute Hospital 12 de Octubre, Hospital Universitario 12 De Octubre, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma de Madrid, Hôpital Pontchaillou, Hospices Civils de Lyon, Hôpital Edouard Herriot, Hôpital Universitaire Dupuytren, CHU Dijon Bourgogne, Centre Hospitalier Régional et Universitaire de Nancy, Universidad San Pablo CEU, HM Hospitales, Université Paris-Est Créteil, Assistance Publique – Hôpitaux de Paris, Hôpital Paris Saint-Joseph, Centre Hospitalier Universitaire de Bordeaux, Hospital Quirónsalud Málaga, Marqués de Valdecilla University Hospital, Instituto de Investigación Marqués de Valdecilla, Hôpital Cochin, Centre Hospitalier Chrétien, Clinique Jules Verne, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria Aragón
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7140136839