P0403 - Development of the Toronto Upper Gastrointestinal Cleaning Score: A Delphi Study

Rishad Khan, MD¹, Nikko Gimpaya, BSc², Jose Ignacio Vargas Dominguez, MD², Sunil Amin, MD, MPH³, Mohammad Bilal, MD⁴, Steven Bollipo, MBBS⁵, Aline Charabaty, MD⁶, Enrique De-Madaria, MD⁷, Almoutaz Hashim, MD⁸, Jan Kral, MD⁹, Katarzyna Pawlak, MD¹⁰, Dalbir S. Sandhu, MD¹¹, Rashid Lui, MBChB¹², Sergio Sanchez-Luna, MD¹³, Keith Siau, MBChB¹⁴, Jeffrey Mosko, MD², Samir Grover, MD^2
1University of Toronto, Toronto, ON, Canada; ²St. Michael's Hospital, Toronto, ON, Canada; ³University of Miami, Leonard M. Miller School of Medicine, Miami, FL; ⁴Minneapolis VA Health Care System, Minneapolis, MN; ⁵John Hunter Hospital, Newcastle, New South Wales, Australia; ⁶Johns Hopkins University School of Medicine, Washington, DC; ⁷Hospital General Universitari d'Alacant, Alicante, Comunidad Valenciana, Spain; ⁸University of Jeddah, Jeddah, Makkah, Saudi Arabia; ⁹Akademie ved Ceske republiky, Praha, Hlavni mesto Praha, Czech Republic; ¹⁰Hospital of the Ministry of Interior and Administration, Szczecin, Zachodniopomorskie, Poland; ¹¹Cleveland Clinic, Cleveland, OH; ¹²Institute of Digestive Diseases, Hong Kong, Hong Kong; ¹³University of New Mexico, Albuquerque, NM; ¹⁴The Dudley Group NHS Foundation Trust, Dudley, England, United Kingdom

Introduction: Esophagogastroduodenoscopy (EGD) is essential for the evaluation of the foregut and is dependent on visualization of the upper gastrointestinal (GI) mucosa pathology. Foregut evaluation can be limited by the presence of mucus, foam, bubbles, and solid materials. Inadequate visualization may necessitate repeat endoscopy, exposing the patient to additional procedural risk. Currently, there is no standardized method to assess mucosal visualization for use in clinical or research settings. By using Delphi methodology, we aimed to develop and establish the content validity of the Toronto Upper Gastrointestinal Cleaning Score (TUGCS).

Methods: We invited an international panel of endoscopy experts and educators to rate potential anatomical items and their associated anchors for importance as indicators of adequacy of mucosal visualization during EGD. The survey included questions regarding the TUGCS with Likert scales, wherein each participant reported their agreement with given statements on a scale of 1 (I strongly disagree with this statement) to 5 (I strongly agree with this statement). After each round in the Delphi process, we evaluated agreement for each survey item and sent back a revised version of the TUGCS to the expert panel for further ratings until we reached a consensus. We defined consensus a priori as ≥80% of experts in a given round, scoring ≥4 on all survey items.

Results: Fourteen experts agreed to be part of the Delphi panel. We initially generated an anatomical framework to represent the upper GI mucosa and anchors for each mucosal portion to represent various levels of visibility through a systematic review. After three rounds of surveys, with response rates of 100%, 100%, and 71% respectively, consensus was achieved. The final TUGCS includes four anatomical areas (fundus, body, antrum, duodenum) and mucosal visualization anchors ranging from 0 (any solid food, blood or blood clots, or other content that could not be suctioned or washed, or an obstruction that prevented adequate visualization of the majority of an anatomical area) to 3 (entire mucosa well seen without the need for suctioning or washing) (Figure).

Discussion: We developed and generated content validity evidence for the TUGCS through rigorous Delphi methodology, reflective of practice across different centers. We are currently gathering validity evidence for the TUGCS in the effort of creating a tool that may be used to judge mucosal visualization for EGD in research and clinical settings.


Figure: Toronto Upper Gastrointestinal Cleaning Score


Disclosures:
Rishad Khan indicated no relevant financial relationships.
Nikko Gimpaya indicated no relevant financial relationships.
Jose Ignacio Vargas Dominguez indicated no relevant financial relationships.
Sunil Amin indicated no relevant financial relationships.
Mohammad Bilal indicated no relevant financial relationships.
Steven Bollipo indicated no relevant financial relationships.
Aline Charabaty indicated no relevant financial relationships.
Enrique De-Madaria indicated no relevant financial relationships.
Almoutaz Hashim indicated no relevant financial relationships.
Jan Kral indicated no relevant financial relationships.
Katarzyna Pawlak indicated no relevant financial relationships.
Dalbir Sandhu indicated no relevant financial relationships.
Rashid Lui indicated no relevant financial relationships.
Sergio Sanchez-Luna indicated no relevant financial relationships.
Keith Siau indicated no relevant financial relationships.
Jeffrey Mosko indicated no relevant financial relationships.
Samir Grover indicated no relevant financial relationships.


Rishad Khan, MD¹, Nikko Gimpaya, BSc², Jose Ignacio Vargas Dominguez, MD², Sunil Amin, MD, MPH³, Mohammad Bilal, MD⁴, Steven Bollipo, MBBS⁵, Aline Charabaty, MD⁶, Enrique De-Madaria, MD⁷, Almoutaz Hashim, MD⁸, Jan Kral, MD⁹, Katarzyna Pawlak, MD¹⁰, Dalbir S. Sandhu, MD¹¹, Rashid Lui, MBChB¹², Sergio Sanchez-Luna, MD¹³, Keith Siau, MBChB¹⁴, Jeffrey Mosko, MD², Samir Grover, MD². P0403 - Development of the Toronto Upper Gastrointestinal Cleaning Score: A Delphi Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.