Applicability of the Barcelona scale to assess the quality of cleanliness of mucosa at esophagogastroduodenoscopy
Henry Córdova, Eva Barreiro Alonso, Edgar Castillo-Regalado, Joaquín Cubiella, Pedro Delgado‐Guillena, Pilar Díez‐Redondo, Martin Galdín, Ana García‐Rodríguez, Luis Hernández, Alaín Huerta, Rodrigo Jover, Henar Núñez, Antonio Rodríguez-D’Jesús, Agustín Seoane, Gerard Surís, Javier Tejedor‐Tejada, Javier Jiménez Sánchez, Francisco Martı́n, Leticia Moreira, Sabela Carballal, Liseth Rivero, Angella Da Fieno, Gherzon Casanova, Irina Luzko, Joan Llach, Glòria Fernández‐Esparrach
Abstract
BACKGROUND AND OBJECTIVES: There are few scales with prospective validation for the assessment of the upper gastrointestinal mucosal cleanliness during an esophagogastroduodenoscopy (EGD). The aim of this study was to develop a valid and reproducible cleanliness scale for use during an EGD. METHODS: We developed a cleanliness scale (Barcelona scale) with a score (0-2 points) of five segments of the upper gastrointestinal tract with thorough cleaning techniques (esophagus, fundus, body, antrum, and duodenum). First, 125 photos (25 of each area) were assessed, and a score was assigned to each image by consensus among 7 experts endoscopists. Subsequently, 100 of the 125 images were selected and the inter- and intra-observer variability of 15 previously trained endoscopists was evaluated using the same images at two different times. RESULTS: In total, 1500 assessments were performed. In 1336/1500 observations (89%) there was agreement with the consensus score, with a mean kappa value of 0.83 (0.45-0.96). In the second evaluation, in 1330/1500 observations (89%) there was agreement with the consensus score, with a mean kappa value of 0.82 (0.45-0.93). The intra-observer variability was 0.89 (0.76-0.99). CONCLUSIONS: The Barcelona cleanliness scale is a valid measure and reproducible with minimal training. Its application in clinical practice is a significant step to standardize the quality of the EGD.