Objective To explore a scoring system for predicting the risk of delayed bleeding after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). Method A retrospective analysis was performed on the data of 296 patients with early gastric cancer (including high-grade intraepithelial neoplasia) who underwent ESD treatment in the Gastroenterology Department of the First Affiliated Hospital of Soochow University from February 2016 to November 2020. Multivariate logistic regression analysis was performed to investigate independent risk factors of delayed bleeding after ESD in early gastric cancers. Weighted points was proportionally assigned based on β regression coefficients value to construct the scoring system. According to the scores and the incidence of delayed bleeding, the receiver operating characteristic curve (ROC curve) was plotted, the area under the curve (AUC) was calculated, and risk stratification based on the scores was performed. Result Multivariate analysis revealed that submucosal fibrosis（OR=12.163,95%CI：2.735-54.102）,resected specimen diameter＞4cm(OR=19.091,95%CI：3.726-97.819), use of anticoagulants and/or antiplatelet drugs were independent risk factors for delayed bleeding after ESD in early gastric cancer (all P＜0.05). Scoring system: 1 point for the use of anticoagulants and/or antiplatelet drugs, 2 points for submucosal fibrosis of the lesion, and 2 points for resected specimen diameter＞4cm. The AUC value of the scoring system was 0.85（95%CI：0.753-0.947，P＜0.001）, of which the cut-off value was 1.5. According to the cut-off value, a score of 0-1 was defined as the low-risk group, and a score of 2-5 was defined as the high-risk group for early gastric cancers after ESD. The incidence of delayed bleeding after ESD in the low-risk group was 1.03% (2/194), and in the high-risk group was 16.67 (17/102). The difference between the two groups was statistically significant (χ2=27.208, P＜0.001). Conclusion The predictive scoring system constructed by the three independent risk factors which were submucosal fibrosis of the lesion ,the use of anticoagulants and/or antiplatelet drugs, and resected specimen diameter＞4cm can effectively identify high-risk patients with delayed bleeding after ESD for early gastric cancers.