Background Esophagogastroduodenoscopy (EGD) is commonly used diagnostic method with no widely accepted quality measure. We assessed quality indicator—composite detection rate (CDR)—consisting of detection of at least one of the following: cervical inlet patch, gastric polyp and post-ulcer duodenal bulb deformation. The aim of the study was to validate CDR according to detection rate of upper gastrointestinal neoplasms (UGN). Methods It was a multicenter, prospective, observational study conducted from January 2019 to October 2019. The endoscopic reports from 2896 symptomatic patients who underwent diagnostic EGD were analyzed. The EGDs were performed in three endoscopy units located in tertiary university hospital, private outpatient clinic and local hospital. Results 64 UGNs were detected. The mean CDR was 21.9%. The CDR correlated with UGN detection rate (R = 0.49, p = 0.045). Based on CDR quartiles, operators were divided into group 1 with CDR < 10%, group 2 with CDR 10–17%, group 3 with CDR 17.1–26%, and group 4 with CDR > 26%. Detection rate of UGN was significantly higher in the group 4 in comparison to group 1 (OR 4.4; 95% CI 2.2 − 9.0). In the multivariate regression model, patient age, male gender and operator’s CDR > 26% were independent risk factors of UGN detection (OR 1.03; 95% CI 1.01 − 1.05, OR 2; 95% CI 1.2 − 3.5, and OR 5.7 95% CI 1.5 − 22.3, respectively). Conclusions The CDR is associated with the detection of upper gastrointestinal neoplasms. This parameter may be a useful quality measure of EGD to be applied in general setting.

Background and Aim The proper visibility of mucosa during esophagogastroduodenoscopy (EGD) is crucial for the detection of early upper gastrointestinal tract lesions. In contrast to colonoscopy, no validated scoring system for the assessment of upper gastrointestinal mucosal cleanliness has been developed so far. The aim of the study was to create and validate standardized grading system (POLPREP) to assess the mucosal cleanliness during EGD. Methods To assess the visibility of mucosa during EGD, 4‐point scale was developed (0–3). Twelve operators assessed 18 images of esophagus, stomach, and duodenum twice (in 2 weeks interval). In validation round, the images and endoscopy reports of 443 EGDs performed in six centers were assessed. Results The inter‐observer accordance of POLPREP was 0.8 (intra‐class correlation coefficient; 0.79 consultants, 0.85 trainees). The intra‐observer repeatability was 0.64 (Fleiss kappa value; 0.64 consultants, 0.64 trainees). The lesions detection rate was significantly higher in clean (scores 2 and 3; 19.7%) than in “unclean” segments (score 1; 7.7%, P = 0.049). Score 3 was associated with over three‐fold higher lesion detection than score 1 (odds ratio 3.2, 95% confidence interval 1.1–9; P = 0.03). Conclusions The proposed POLPREP scale allows for unified assessment of upper gastrointestinal tract mucosal cleanliness. The higher cleanliness scores are related with greater upper gastrointestinal pathologies detection.

The diagnosis of atrophic gastritis (AG) and intestinal metaplasia (IM) is a crucial factor in the surveillance strategy of gastric cancer. Endoscopic visualization of AG and IM is not yet recommended as the sole diagnosis; however, some data indicate that it could have high accuracy. Mapping biopsies are the gold standard for diagnosing AG and IM, which results in an increased number of biopsies. We found out that endoscopic diagnosis of AG and IM is insufficient to replace biopsy in a real-life scenario. Age and endoscopic diagnosis of gastritis are the risk factors of AG, IM, and dysplasia diagnosis. Applying the age criteria with or without an endoscopic diagnosis of gastritis reduces the number of biopsies without significant effect on the diagnosis of AG and IM.

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