Prospective validation of the Barcelona scale for the assessment of cleanliness in upper gastrointestinal endoscopy

Aims Proper visibility of the mucosa is required in order to detect clinically significant lesions (CSL) in the upper gastrointestinal (GI) tract. However, there are few scales with prospective validation for the assessment of the upper GI mucosal cleanliness during upper GI endoscopy.

Aim. To assess the relationship between the presence of CSL in the upper GI tract and the mucosal cleanliness evaluated by the Barcelona Scale.

Methods We conducted a multicenter and prospective study in 14 Spanish hospitals. Patients who underwent a diagnostic upper GI endoscopy were included. Exclusion criteria included urgent, and follow-up upper GI endoscopies, and patients with upper GI hemorrhage, suspicion of intestinal obstruction or with history of gastrectomy. After all necessary cleansing maneuvers, 5 segments (esophagus, fundus, corpus, antrum and duodenum) were assigned a score from 0 (not assessable due to the presence of content) to 2 (mucosa is fully visualized), so 10 was the maximum score. The following were considered CSL: reflux esophagitis, Barrett's esophagus, ulcers, malignant tumors, atrophic gastritis, gastric intestinal metaplasia, gastric polyps and subepithelial lesions.

Results A total of 641 patients were included, who obtained a median score of 9 (2-10). The average time needed to complete the endoscopy was 8±2.69 minutes (1.16-26). Three hundred and thirty-six CSL were identified in 268 patients (41.8%). Of these, 88.8% (238/268 patients) had a total cleanliness score≥8. Reflux esophagitis, atrophic gastritis and gastric polyps were the most frequent CSL and achieved a score≥8 in 84.2%, 92.5% and 93.9% of cases, respectively.

Conclusions A significantly greater number of CSL were detected in upper GI endoscopies with excellent cleanliness. Reflux esophagitis, atrophic gastritis and gastric polyps showed increased detection with greater cleanliness. [1]

Publication History

Article published online:
15 April 2024

• References

• 1 Córdova H, Barreiro-Alonso E, Castillo-Regalado E. et al. A al. Applicability of the Barcelona scale to assess the quality of cleanliness of mucosa at EGD. Gastroenterol Hepatol 2023