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. 2025 Aug 13:18:17562848251363873.
doi: 10.1177/17562848251363873. eCollection 2025.

Prospective validation of the Barcelona scale for the assessment of mucosal cleanliness during upper gastrointestinal endoscopy

Henry Córdova  1 , Irina Luzko  1 , Javier Tejedor-Tejada  2 , Edgar Castillo-Regalado  3 , Eva Barreiro-Alonso  4 , Pedro Delgado-Guillena  5 , Pilar Diez Redondo  6 , Martin Galdin  7 , Ana García-Rodríguez  8 , Luis Hernández  9 , Ma Henar Núñez Rodríguez  6 , Agustín Seoane  10 , Javier Jiménez Sánchez  11 , Joaquín Cubiella  12 , Rodrigo Jover  13 , Antonio Rodríguez-D'Jesús  14 , Cautar El Maimouni  1 , Leticia Moreira  1 , Oswaldo Ortiz  1 , Joan Llach  1 , Gloria Fernández-Esparrach  15
Affiliations

Prospective validation of the Barcelona scale for the assessment of mucosal cleanliness during upper gastrointestinal endoscopy

Henry Córdova et al. Therap Adv Gastroenterol. .

Abstract

Background: Some validated scales for assessing upper gastrointestinal (UGI) cleanliness have been developed, though none have been widely implemented.

Objectives: To evaluate the association between the presence of clinically significant lesions (CSLs) in the UGI tract and mucosal cleanliness using the Barcelona Scale. The secondary objective includes assessing the safety of water lavage during esophagogastroduodenoscopy (EGD).

Design: Multicenter prospective study conducted in 14 hospitals in Spain.

Methods: From January 2022 to December 2023, patients undergoing EGD were included. After cleansing, the esophagus, fundus, corpus, antrum, and duodenum were scored from 0 (unassessable due to content) to 2 (fully visualized mucosa), with a maximum score of 10.

Results: A total of 641 patients were included, and 3205 segments were assessed: 2594 scored "2," 604 "1," and 7 "0." In 272 patients, 327 CSLs were identified: 93 (14.5%) in the esophagus, 223 (34.8%) in the stomach, and 11 (1.7%) in the duodenum. Only five cases of neoplasia were found, all in segments scored "2" (global score ⩾ 9). The CSL detection rates were 0%, 5.3%, and 11.4% for scores 0, 1, and 2, respectively (p < 0.001), with a significantly higher rate for score "2" compared to "1" (OR 2.29, 95% CI 1.57-3.34). Besides the degree of cleanliness, several factors were independently associated with CSL detection, including the use of a high-definition endoscope (OR 1.87, 95% CI 1.14-3.23), male sex (OR 1.54, 95% CI 1.1-2.17), and age ⩾58 years (OR 1.54, 95% CI 1.09-2.17).

Conclusion: The Barcelona scale may be a valid instrument for assessing the quality of cleanliness during EGD in real clinical practice, as it improves the detection of CSL in the UGI.

Keywords: cleanliness; esophagogastroduodenoscopy; quality; upper gastrointestinal tract; visualization.

Plain language summary

The Barcelona scale is a valid and safe instrument for assessing the quality of cleanliness during EGD in real clinical practice This study prospectively assessed the validity of the Barcelona Cleanliness scale as a tool for evaluating cleanliness during real-time EGD and demonstrated its significant association with the detection of CSL. This clear and simple scale is a 3-point scoring system (0 to 2) that assesses the entire upper GI tract (esophagus, stomach and duodenum) and divides the stomach into three segments: fundus, body and antrum. The Barcelona scale has demonstrated to be a valid and reproducible scale with minimal training among endoscopists with different levels of expertise. We believe these findings might help endoscopists to assess the mucosal cleanliness quality during EGD, using the Barcelona scale.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

this is a diagram depicting the cleansing stages on a scale of 0-2 titled barcelona scale
Figure 1.
Description of the Barcelona cleanliness scale. Source: Reproduced with permission.
Bar graph showing the percentage of the total number of gastric patients with at least one clinically significant lesion (CSL), along with corresponding number of patients having at least one gastric CSL per global scores of 1 to 6.
Figure 2.
Global score distribution in the stomach and number of patients with at least one gastric CSL per global score (p = 0.03). CSL, clinically significant lesion.
The diagram illustrates a study flow chart, detailing the consecutive inclusion criteria, exclusion criteria, eligible patient count, assessment processes, and scoring results for esophagus, stomach, duodenum, and other body parts.
Figure 3.
Study flow diagram.
See this image and copyright information in PMC

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