Background and objectives: There are few scales with prospective validation forthe assessment

of the upper gastrointestinal mucosal cleanliness during an esophagogastroduodenoscopy (EGD).

The aim of this study was to develop a valid and reproducible cleanliness scale for use during

an EGD.

Methods: We developed a cleanliness scale (Barcelona scale) with a score (0---2 points) of five

segments of the upper gastrointestinal tract with thorough cleaning techniques (esophagus,

fundus, body, antrum, and duodenum). First, 125 photos (25 of each area) were assessed, and a

score was assigned to each image by consensus among 7 experts endoscopists. Subsequently, 100

of the 125 images were selected and the inter- and intra-observer variability of 15 previously

trained endoscopists was evaluated using the same images at two different times.

Results: In total, 1500 assessments were performed. In 1336/1500 observations (89%) there

was agreement with the consensus score, with a mean kappa value of 0.83 (0.45---0.96). In the

second evaluation, in 1330/1500 observations (89%) there was agreement with the consensus

score, with a mean kappa value of 0.82 (0.45---0.93). The intra-observer variability was 0.89

(0.76---0.99).

Conclusions: The Barcelona cleanliness scale is a valid measure and reproducible with minimal

training. Its application in clinical practice is a significant step to standardize the quality of the

EGD.