Prospective validation of the Barcelona scale for the assessment of mucosal cleanliness during upper gastrointestinal endoscopy.

Abstract

Background: Some validated scales for assessing upper gastrointestinal (UGI) cleanliness have been developed, though none have been widely implemented.

Objectives: To evaluate the association between the presence of clinically significant lesions (CSLs) in the UGI tract and mucosal cleanliness using the Barcelona Scale. The secondary objective includes assessing the safety of water lavage during esophagogastroduodenoscopy (EGD).

Design: Multicenter prospective study conducted in 14 hospitals in Spain.

Methods: From January 2022 to December 2023, patients undergoing EGD were included. After cleansing, the esophagus, fundus, corpus, antrum, and duodenum were scored from 0 (unassessable due to content) to 2 (fully visualized mucosa), with a maximum score of 10.

Results: A total of 641 patients were included, and 3205 segments were assessed: 2594 scored "2," 604 "1," and 7 "0." In 272 patients, 327 CSLs were identified: 93 (14.5%) in the esophagus, 223 (34.8%) in the stomach, and 11 (1.7%) in the duodenum. Only five cases of neoplasia were found, all in segments scored "2" (global score ⩾ 9). The CSL detection rates were 0%, 5.3%, and 11.4% for scores 0, 1, and 2, respectively (p < 0.001), with a significantly higher rate for score "2" compared to "1" (OR 2.29, 95% CI 1.57-3.34). Besides the degree of cleanliness, several factors were independently associated with CSL detection, including the use of a high-definition endoscope (OR 1.87, 95% CI 1.14-3.23), male sex (OR 1.54, 95% CI 1.1-2.17), and age ⩾58 years (OR 1.54, 95% CI 1.09-2.17).

Conclusion: The Barcelona scale may be a valid instrument for assessing the quality of cleanliness during EGD in real clinical practice, as it improves the detection of CSL in the UGI.