Scoring system assessing mucosal visibility of upper gastrointestinal tract: The POLPREP scale

Abstract

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 Toronto Upper Gastrointestinal Cleaning Score: a prospective validation study

“…Prior studies have evaluated mucosal visualization in the context of gastric cleaning agents but lacked structured validation of the scales. One previous study evaluated the validity of an upper endoscopy mucosal visualization scale; however, the scale was not developed systematically, relied on lumen photographs as opposed to live EGDs or videos, and lacked elements of validity evidence such as response process and internal consistency 9 . Similarly to widely used bowel preparation scales such as the OBPS and BBPS 10 , we established the quality of the TUGCS in an authentic clinical setting using a robust methodology.…”

“…Additionally, details regarding development of these scales are scant. One recent scale demonstrated some validity evidence; however, it was limited by the use of EGD images rather than live or video-based assessment [9]. In contrast, there are a range of lower GI visualization scales with strong validity evidence, such as the Ottawa Bowel Preparation Scale (OBPS) and Boston Bowel Preparation Scale (BBPS) [10][11][12].…”

Detection and Characterization of Early Gastric Cancer

“…A high-quality examination during an upper gastrointestinal endoscopy requires optimal mucosal visualization (1,2,15). The use of mucolytic and defoaming agents, such as simethicone and N-acetylcysteine, improves the visibility of gastric mucosa compared to water and is associated with an increased rate of detection of early gastric cancer (15)(16)(17)(18)(19). Recommended in Japanese guidelines on endoscopic diagnosis of EGC but often overlooked in the west, the preparation of the upper gastrointestinal tract with a mucolytic agent 10 to 30 min before endoscopy is an inexpensive method, with a low frequency of adverse reactions/minimal patient burden, that can help obtain the optimal gastric cleanliness (1,15,20,21).…”

Prospective validation of a cleanliness scoring system for the upper digestive tract – the visual study

“…Patients who underwent a complete diagnostic EGD were included. The degree of UGI tract cleanliness was assessed using the PUCS, each segment (esophagus, stomach and duodenum) was scored 0–3 (0=inadequate, 1=poor, 2=good, 3=excellent) 1 .…”