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Endoscopy 2023; 55(02): 121-128
DOI: 10.1055/a-1865-4180
Original article

The Toronto Upper Gastrointestinal Cleaning Score: a prospective validation study

Rishad Khan 
 1   Department of Medicine, University of Toronto, Toronto, Canada
,
Nikko Gimpaya
 2   Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
,
Jose I. Vargas 
 3   Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
,
Anushka Ramkissoon
 2   Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
,
Samir Seleq
 2   Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
,
Reza Gholami
 2   Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
,
Hisham J. Akhtar
 2   Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
,
Rishi Bansal
 2   Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
,
Michael A. Scaffidi 
 2   Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
,
Sunil Amin
 4   Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States
,
Steven Bollipo
 5   Gastroenterology Department, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia
,
Jan Kral
 6   Institute for Clinical and Experimental Medicine, Hepatogastroenterology Department, Prague, Czech Republic
,
Rashid Lui
 7   Division of Gastroenterology and Hepatology, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
,
Katarzyna M. Pawlak 
 8   Hospital of the Ministry of Interior and Administration, Szczecin, Poland
,
Dalbir S. Sandhu 
 9   Division of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, Ohio, United States
,
Mohammad Bilal 
10   Minneapolis VA Health Care Centre, University of Minnesota, Minneapolis, Minnesota, United States
,
Enrique de-Madaria
11   Gastroenterology Department, Alicante University General Hospital, ISABIAL, Alicante, Spain
,
Keith Siau 
12   Medical and Dental Sciences, Institute of Translational Medicine, University of Birmingham, Birmingham, United Kingdom
,
Aline Charabaty
13   Division of Gastroenterology, Johns Hopkins–Sibley Memorial Hospital, Washington DC, United States
,
Almoutaz Hashim
14   Department of Medicine, University of Jeddah, Jeddah, Saudi Arabia
,
Sergio A. Sánchez-Luna 
15   Basil I. Hirschowitz Endoscopic Center of Excellence, Division of Gastroenterology and Hepatology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, United States
,
Christopher W. Teshima
 1   Department of Medicine, University of Toronto, Toronto, Canada
 2   Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
16   The Centre for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael’s Hospital, Toronto, Canada
,
Gary R. May
 1   Department of Medicine, University of Toronto, Toronto, Canada
 2   Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
16   The Centre for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael’s Hospital, Toronto, Canada
,
Jeffrey D. Mosko
 1   Department of Medicine, University of Toronto, Toronto, Canada
 2   Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
16   The Centre for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael’s Hospital, Toronto, Canada
17   Li Ka Shing Knowledge Institute, Toronto, Canada
,
Catharine M. Walsh 
18   Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, Hospital for Sick Children, Toronto, Canada
19   The Wilson Centre, University of Toronto, Toronto, Canada
,
Samir C. Grover 
 1   Department of Medicine, University of Toronto, Toronto, Canada
 2   Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
16   The Centre for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael’s Hospital, Toronto, Canada
17   Li Ka Shing Knowledge Institute, Toronto, Canada
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Abstract

Background Assessment of mucosal visualization during esophagogastroduodenoscopy (EGD) can be improved with a standardized scoring system. To address this need, we created the Toronto Upper Gastrointestinal Cleaning Score (TUGCS).

Methods We developed the TUGCS using Delphi methodology, whereby an international group of endoscopy experts iteratively rated their agreement with proposed TUGCS items and anchors on a 5-point Likert scale. After each Delphi round, we analyzed responses and refined the TUGCS using an 80 % agreement threshold for consensus. We used the intraclass correlation coefficient (ICC) to assess inter-rater and test–retest reliability. We assessed internal consistency with Cronbach’s alpha and item-total and inter-item correlations with Pearson’s correlation coefficient. We compared TUGCS ratings with an independent endoscopist’s global rating of mucosal visualization using Spearman’s ρ.

Results We achieved consensus with 14 invited participants after three Delphi rounds. Inter-rater reliability was high at 0.79 (95 %CI 0.64–0.88). Test–retest reliability was excellent at 0.83 (95 %CI 0.77–0.87). Cronbach’s α was 0.81, item-total correlation range was 0.52–0.70, and inter-item correlation range was 0.38–0.74. There was a positive correlation between TUGCS ratings and a global rating of visualization (r = 0.41, P = 0.002). TUGCS ratings for EGDs with global ratings of excellent were significantly higher than those for EGDs with global ratings of fair (P = 0.01).

Conclusion The TUGCS had strong evidence of validity in the clinical setting. The international group of assessors, broad variety of EGD indications, and minimal assessor training improves the potential for dissemination.

Appendix 1, Figs. 1 s, 2 s



Publication History

Received: 31 January 2022

Accepted after revision: 31 May 2022

Accepted Manuscript online:
31 May 2022

Article published online:
31 August 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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