Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
Endotherapy, H-T. Medical Center, Tychy, Poland.
J Gastroenterol Hepatol. 2022 Jan;37(1):164-168. doi: 10.1111/jgh.15662. Epub 2021 Aug 24.
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.
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.
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).
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.
在食管胃十二指肠镜检查（EGD）过程中，黏膜的适当可视性对于检测早期上消化道病变至关重要。与结肠镜检查不同，目前尚未开发出用于评估上消化道黏膜清洁度的经过验证的评分系统。本研究的目的是创建和验证一种标准化的分级系统（POLPREP），以评估 EGD 期间的黏膜清洁度。
为了评估 EGD 过程中黏膜的可视性，开发了 4 分制（0-3 分）。12 名操作人员在 2 周的间隔内对食管、胃和十二指肠的 18 张图像进行了两次评估。在验证轮次中，对来自 6 个中心的 443 例 EGD 的图像和内镜报告进行了评估。
POLPREP 的观察者间一致性为 0.8（组内相关系数；0.79 名顾问，0.85 名受训者）。观察者内的重复性为 0.64（Fleiss kappa 值；0.64 名顾问，0.64 名受训者）。在清洁（评分 2 和 3；19.7%）段与“不洁”段（评分 1；7.7%，P=0.049）相比，病变检出率显著更高。评分 3 与评分 1 相比，病变检出率高出三倍以上（比值比 3.2，95%置信区间 1.1-9；P=0.03）。
所提出的 POLPREP 评分系统可用于统一评估上消化道黏膜清洁度。较高的清洁评分与更高的上消化道病变检出率相关。
