Upper Gastrointestinal Cleaning Scores: A Narrative Review

Abstract

Background :

Esophagogastroduodenoscopy (EGD) relies on clear mucosal visualization for accurate diagnosis. Currently, there is no validated scoring system for assessing upper gastrointestinal (GI) mucosal cleanliness, unlike colonoscopy, leading to a risk of missing early gastric cancers.

Materials and Methods:

In this review, we identified three scores in our search related to GI cleaning scores and evaluated three scoring systems for upper GI mucosal cleanliness: the POLPREP scale, the Toronto Upper Gastrointestinal Cleaning Score (TUGCS), and the Barcelona Cleanliness Scale. Each study's methodology, validation process, and results were analyzed for reliability and applicability. The POLPREP scale evaluates the esophagus, stomach, and duodenum with scores from 0 (poor visibility) to 3 (excellent visibility). It demonstrated good intra- and inter-observer repeatability through image-based assessments. The TUGCS, developed using the Delphi methodology, focuses on the fundus, body, antrum, and duodenum, excluding the esophagus.

Results :

It showed excellent test-retest reliability (score 0.83) using video recordings. The Barcelona scale assesses cleanliness in five upper GI segments, scoring from 0 (non-aspirate solid or semi-solid material obstructing visibility) to 2 (nearly 100% mucosal visibility). It also demonstrated high inter- and intra-observer agreement (kappa value 0.82) through image-based assessments.

Conclusion

All evaluated studies highlight the need for standardized scales to improve mucosal visualization during EGD. Each study confirmed the repeatability and reliability of their scoring systems, despite methodological differences.

 Therefore, developing a standardized, validated scoring system for upper GI cleanliness is essential for improving EGD diagnostic accuracy.