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

Aims No widely accepted cleanliness score has been validated for esophagogastroduodenoscopy (EGD) so far. The aim of our study was to assess the relationship between the presence of UGI lesions and a recently created polprep upper-gastrointestinal cleanliness scale (PUCS)¹.

Methods A prospective study was conducted at 5 centers. 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].

Results Of 995 patients enrolled in the study, 2985 segments were evaluated: score 3 – 2154, score 2 – 757 and score 1 – 74 segments respectively. The overall clinically significant condition detection rate (CSCDR) was 21.9% – 21.6%, 23.8% and 13.5% CSCDR rates for scores 3, 2 and 1 respectively (p=0.043 for score 1 versus 2; p=0.22 for score 2 versus 3). Similarly, gastric lesion detection rate was 25.8%, 23.6% and 10.7% for scores 3, 2 and 1 respectively (p=0.027 for score 1 versus 2; p=0.45 for score 2 versus 3). Finally, of 27 cases of UGI neoplasia diagnosed in the study, 17 were in areas scored as 3, 10 in those with a score of 2 but none in areas scored as 1.

Conclusions Significantly higher number of UGI clinically significant conditions and gastric lesions were detected in areas of good cleanliness as assessed by PUCS (score 2). There were no significant differences between good and excellent PUCS (scores 2 and 3). The comparison of UGI neoplastic lesion detection warrants further investigation.

Conflicts of interest

Tomasz Romańczyk: Contact: Gilead, Pfizer, Theravance, Celgene, Takeda, BMS, Jannsen, Celltrion, Abbvie, Ferring, Morphic Training Grants: Ferring, Biocodex Prateek Sharma: Consultant: Bausch, Boston Scientific Corporation, CDx Labs, Covidien LP, Exact Sciences, Fujifilm Medical Systems USA, Inc., Lucid, Lumendi, Medtronic, Phathom, Olympus, Takeda, Samsung Bioepis Grant / Contract: Cosmo Pharmaceuticals, Covidien, Docbot, ERBE USA Inc., Fujifilm Holdings America Corporation, Ironwood Pharmaceuticals, Inc., Medtronic USA, Inc., OlympusMichał F. Kamiński Consultant: Olympus, Microtech, ERBE lecturer: Fujifilm, Medtronic, Boston Scientific, Ipsen, Norgine Advisory board: ALFAsigma

• 1 Romańczyk M, Ostrowski B, Kozłowska-Petriczko K. et al. Scoring system assessing mucosal visibility of upper gastrointestinal tract: The POLPREP scale. J Gastroenterol Hepatol 2022; 37: 164-168

Publication History

Article published online:
14 April 2023