TY - JOUR
T1 - The Gastroscopy RAte of Cleanliness Evaluation (GRACE) Scale
T2 - an international reliability and validation study
AU - Esposito, Gianluca
AU - Dilaghi, Emanuele
AU - Costa-Santos, Cristina
AU - GRACE Investigators
AU - Ligato, Irene
AU - Annibale, Bruno
AU - Dinis-Ribeiro, Mario
AU - Areia, Miguel
AU - Arantes, Vitor N.
AU - Bergman, Jacques
AU - Bisschops, Raf
AU - de Jonge, Pieter J. . F.
AU - Di Matteo, Francesco
AU - Ebigbo, Alanna
AU - Ferlitsch, Monika
AU - Giljaca, Vanja
AU - Hassan, Cesare
AU - Hucl, Tomas
AU - Kuvaev, Roman
AU - Leclercq, Philippe
AU - Matysiak-Budnik, Tamara
AU - Mori, Yuichi
AU - Moss, Alan
AU - Perez-Cuadrado-Robles, Enrique
AU - Pouw, Roos E.
AU - Rex, Douglas K.
AU - de Santiago, Enrique Rodriguez
AU - Siersema, Peter D.
AU - Tham, Tony C.
AU - Triantafyllou, Konstantinos
AU - Voiosu, Andrei
AU - Weusten, Bas
AU - Andrisani, Gianluca
AU - Angeletti, Stefano
AU - Ayoub, Mousa
AU - Bac, Simon
AU - Boonstra, Kirsten
AU - Borren, Nienke
AU - Capogreco, Antonio
AU - Falquina, Irene Chivato Martin
AU - Chaves, Jessica
AU - Citterio, Nicolo
AU - Dal Buono, Arianna
AU - Dell'Unto, Elisabetta
AU - Dragan, Victor
AU - Elvas, Luis
AU - Filimendikova, Ksenia
AU - Frick, Adrian
AU - Guardiola, John
AU - Meijer, Berrie
AU - van de Ven, Steffi
N1 - Publisher Copyright:
© 2024. Thieme All rights reserved.
PY - 2024/11/8
Y1 - 2024/11/8
N2 - Background Muco sal 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. Methods 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 2week 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. Results 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). Conclusions The GRACE scale showed good interobserver agreement, reliability, and validity. The widespread use of this scale could enhance quality and standardize the assessment of muco sal cleanliness during UGI endoscopy, pushing endoscopists to strive for excellent visibility and reducing the risk of missed lesions.
AB - Background Muco sal 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. Methods 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 2week 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. Results 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). Conclusions The GRACE scale showed good interobserver agreement, reliability, and validity. The widespread use of this scale could enhance quality and standardize the assessment of muco sal cleanliness during UGI endoscopy, pushing endoscopists to strive for excellent visibility and reducing the risk of missed lesions.
UR - https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=eur_pure&SrcAuth=WosAPI&KeyUT=WOS:001351078200001&DestLinkType=FullRecord&DestApp=WOS_CPL
U2 - 10.1055/a-2422-0856
DO - 10.1055/a-2422-0856
M3 - Article
C2 - 39321961
SN - 0013-726X
JO - Endoscopy
JF - Endoscopy
ER -