Esposito Gianluca, Dilaghi Emanuele, Costa-Santos Cristina, Ligato Irene, Annibale Bruno, Dinis-Ribeiro Mário, Areia Miguel
Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine of the University of Porto, Porto, Portugal.
Endoscopy. 2025 Apr;57(4):312-320. doi: 10.1055/a-2422-0856. Epub 2024 Sep 25.
Mucosal visualization during upper gastrointestinal (UGI) endoscopy can be impaired by the presence of foam, bubbles, and mucus. Some UGI endoscopy visibility scales have been proposed but have not undergone multicenter validation. This study aimed to develop and validate the Gastroscopy RAte of Cleanliness Evaluation (GRACE) scale.
A multicenter, international, cross-sectional study was conducted. The GRACE scale is based on a score from 0 (worst) to 3 (excellent) for esophagus, stomach, and duodenum, for a total ranging from 0 to 9. In phase 1, four expert endoscopists evaluated 60 images twice, with a 2-week interval between rounds; in phase 2, the same 60 images were scored twice by one expert and one nonexpert endoscopist from 27 endoscopy departments worldwide. For reproducibility assessment and real-time validation, the scale was applied to consecutive patients undergoing gastroscopy at each center.
On internal validation, interobserver agreement was 0.81 (95 %CI 0.73-0.87) and 0.80 (95 %CI 0.72-0.86), with reliability of 0.73 (95 %CI 0.63-0.82) and 0.72 (95 %CI 0.63-0.81), in the two rounds, respectively. On external validation, overall interobserver agreement was 0.85 (95 %CI 0.82-0.88) and reliability was 0.79 (95 %CI 0.73-0.84). In real-time evaluation, the overall proportion of correct classifications was 0.80 (95 %CI 0.77-0.82).
The GRACE scale showed good interobserver agreement, reliability, and validity. The widespread use of this scale could enhance quality and standardize the assessment of mucosal cleanliness during UGI endoscopy, pushing endoscopists to strive for excellent visibility and reducing the risk of missed lesions.
上消化道（UGI）内镜检查期间，泡沫、气泡和黏液的存在会妨碍黏膜观察。已经提出了一些上消化道内镜可见度量表，但尚未经过多中心验证。本研究旨在开发并验证胃镜清洁度评估（GRACE）量表。
开展了一项多中心、国际性横断面研究。GRACE量表根据食管、胃和十二指肠的评分从0（最差）到3（最佳），总分范围为0至9。在第一阶段，四名内镜专家对60张图像进行了两次评估，两轮评估间隔2周；在第二阶段，来自全球27个内镜科室的一名专家和一名非专家内镜医师对相同的60张图像进行了两次评分。为进行重复性评估和实时验证，该量表应用于各中心连续接受胃镜检查的患者。
在内部验证中，两轮评估的观察者间一致性分别为0.81（95%CI 0.73 - 0.87）和0.80（95%CI 0.72 - 0.86），可靠性分别为0.73（95%CI 0.63 - 0.82）和0.72（95%CI 0.63 - 0.81）。在外部验证中，总体观察者间一致性为0.85（95%CI 0.82 - 0.88），可靠性为0.79（95%CI 0.73 - 0.84）。在实时评估中，正确分类的总体比例为0.80（95%CI 0.77 - 0.82）。
GRACE量表显示出良好的观察者间一致性、可靠性和有效性。该量表的广泛应用可提高上消化道内镜检查期间黏膜清洁度评估的质量并使其标准化，促使内镜医师力求获得极佳的视野并降低漏诊病变的风险。
