International Validation of a Novel PEACE Scale to Improve the Quality of Upper Gastrointestinal Mucosal Inspection During Endoscopy

Marcin Romańczyk; Madhav Desai; Michal F Kamiński; Seiichiro Abe; Asma A Alkandari; Torsten Beyna; Raf Bisschops; Krzysztof Budzyń; Monika Bugdol; Samir C Grover; C Prakash Gyawali; Haruhiro Inoue; Prasad G Iyer; Helmut Messmann; Krish Ragunath; Yutaka Saito; Sachin Srinivasan; Christopher Teshima; Rena Yadlapati; Cesare Hassan; Prateek Sharma

doi:10.14309/ctg.0000000000000786

International Validation of a Novel PEACE Scale to Improve the Quality of Upper Gastrointestinal Mucosal Inspection During Endoscopy

Clin Transl Gastroenterol. 2024 Nov 14. doi: 10.14309/ctg.0000000000000786. Online ahead of print.

Authors

Marcin Romańczyk^{1

2

3}, Madhav Desai⁴, Michal F Kamiński^{5

6

7}, Seiichiro Abe⁸, Asma A Alkandari⁹, Torsten Beyna¹⁰, Raf Bisschops¹¹, Krzysztof Budzyń^{1

2

3}, Monika Bugdol¹², Samir C Grover¹³, C Prakash Gyawali¹⁴, Haruhiro Inoue¹⁵, Prasad G Iyer¹⁶, Helmut Messmann¹⁷, Krish Ragunath^{18

19}, Yutaka Saito⁸, Sachin Srinivasan²⁰, Christopher Teshima²¹, Rena Yadlapati²², Cesare Hassan^{23

24}, Prateek Sharma^{20

25}

Affiliations

¹ Department of Gastroenterology, Faculty of Medicine, Academy of Silesia, Katowice, Poland.
² Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
³ Endoterapia, H-T, Centrum Medyczne, Tychy, Poland.
⁴ Interventional Gastroenterology, Department of Surgery, University of Texas Health Science Center, Houston, Texas, USA.
⁵ Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland.
⁶ Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
⁷ Institute of Health and Society, University of Oslo, Oslo, Norway.
⁸ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
⁹ Al Jahra Hospital, Kuwait, Kuwait.
¹⁰ Department of Internal Medicine, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany.
¹¹ Department of Gastroenterology and Hepatology, Katholieke Universiteit Leuven, Leuven, Belgium.
¹² Department of Medical Informatics and Artificial Intelligence, Faculty of Biomedical Engineering, Silesian University of Technology, Gliwice, Poland.
¹³ Division of Gastroenterology and Hepatology, Scarborough Health Network Research Institute, University of Toronto, Toronto, Ontario, Canada.
¹⁴ Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA.
¹⁵ Digestive Disease Centre, Showa University Koto Toyosu Hospital, Tokyo, Japan.
¹⁶ Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
¹⁷ Department of Gastroenterology, Faculty of Medicine, University of Augsburg, Augsburg, Germany.
¹⁸ Faculty of Health Sciences, Curtin Medical School, Curtin University, Perth, Western Australia, Australia.
¹⁹ Department of Gastroenterology, Royal Perth Hospital, Perth, Western Australia, Australia.
²⁰ Division of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA.
²¹ Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, Division of Gastroenterology and Hepatology, Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada.
²² Division of Gastroenterology, University of California San Diego, San Diego, California, USA.
²³ Department of Biomedical Sciences, Humanitas University, Milan, Italy.
²⁴ Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy.
²⁵ Division of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Kansas, USA.

PMID: 39700029
DOI: 10.14309/ctg.0000000000000786

Abstract

Introduction: The performance of a high quality esophagogastroduodenoscopy (EGD) is dependent on the mucosal cleanliness. Recently, the Polprep: Effective Assessment of Cleanliness in EGD (PEACE) scale was created to assess the degree of mucosal cleanliness during EGD. The aim of this study was to validate this scoring system in a cohort of international endoscopists.

Methods: In total, 39 EGD videos, with different degrees of mucosal cleanliness were retrieved from a previously conducted prospective trial. All experts rated the cleanliness of the mucosa on each video using the PEACE scale. To evaluate agreement of all scores (0-3), intraclass correlation coefficient 2.1 was used. The agreement on adequate (scores 2 and 3) and inadequate (scores 0 and 1) cleanliness was assessed using kappa values.

Results: Videos evaluating esophagus, stomach, and duodenum cleanliness were reviewed by 16 endoscopists. The PEACE scores demonstrated good agreement (intraclass correlation coefficient 0.82, 95% CI 0.75-0.89), especially for esophagus (0.84; 95% CI 0.71-0.95) and stomach (0.81; 95% CI 0.69-0.91), while agreement was moderate for the duodenum (0.69; 95% CI 0.51-0.87). The agreement was similar between Eastern (0.86; 95% CI 0.79-0.92) and Western experts (0.80; 95% CI 0.72-0.88). Similarly, agreement regarding adequate cleanliness was comparable between Eastern (0.70; 95% CI 0.55-0.85) and Western (0.74; 95% CI 0.64-0.84) endoscopists being overall 0.75 (95% CI 0.65-0.85).

Discussion: The PEACE scoring system is a simple and reliable scale to assess the cleanliness during EGD. The score is now validated among international experts with high concordance, justifying its use in clinical practice.