To assess the performance of the Limoges Bleeding Score¹ (LBS) in predicting delayed bleeding after colorectal ESD. The LBS has been recently developed to stratify bleeding risk after colorectal ESD, but external validation on independent cohorts is limited. 

We retrospectively analyzed consecutive patients undergoing colorectal ESD at our tertiary referral center between November 2020 and November 2025. For each included patient, the LBS was calculated according to the original definition. 

Delayed bleeding was defined as post-ESD bleeding event needing a prolongation of hospitalization, readmission, new endoscopy (or surgery or angiography), or a blood transfusion, and occurring at least 6 hours after, and within 30 days after the procedure.

We compared LBS values between patients with and without delayed bleeding using Mann-Whitney U test / t-test, and quantified the effect size, using rank-biserial correlation.

Three hundred twenty patients were retrospectively analyzed. Of these patients, thirty-nine were excluded due to missing data. A total of 281 colorectal ESD procedures were included. Delayed bleeding occurred in 19 (6,7%) of cases. LBS was slightly but significantly higher in the bleeding group (median 4 [IQR 3–4.5]) vs the non-bleeding group (3 [IQR 1–4]) (p = 0.02). The effect size indicated a moderate difference between groups (rank-biserial correlation = 0.31).

In this external validation cohort, the Limoges Bleeding Score demonstrated a good ability to assess the risk of delayed bleeding after colorectal ESD. If confirmed in larger prospective studies, LBS may support standardized risk stratification and guide intra- and post-procedural therapeutic strategies.