{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T20:16:55Z","timestamp":1776716215635,"version":"3.51.2"},"reference-count":28,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:p>\n            Background\u2002Mucosal 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.<\/jats:p><jats:p>\n            Methods\u2002A 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.\u200aIn phase 1, four expert endoscopists evaluated 60 images twice, with a 2-week 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.<\/jats:p><jats:p>\n            Results\u2002On internal validation, interobserver agreement was 0.81 (95\u200a%CI 0.73\u20130.87) and 0.80 (95\u200a%CI 0.72\u20130.86), with reliability of 0.73 (95\u200a%CI 0.63\u20130.82) and 0.72 (95\u200a%CI 0.63\u20130.81), in the two rounds, respectively. On external validation, overall interobserver agreement was 0.85 (95\u200a%CI 0.82\u20130.88) and reliability was 0.79 (95\u200a%CI 0.73\u20130.84). In real-time evaluation, the overall proportion of correct classifications was 0.80 (95\u200a%CI 0.77\u20130.82).<\/jats:p><jats:p>\n            Conclusions\u2002The GRACE scale showed good interobserver agreement, reliability, and validity. The widespread use of this scale could enhance quality and standardize the assessment of mucosal cleanliness during UGI endoscopy, pushing endoscopists to strive for excellent visibility and reducing the risk of missed lesions.<\/jats:p>","DOI":"10.1055\/a-2422-0856","type":"journal-article","created":{"date-parts":[[2024,9,25]],"date-time":"2024-09-25T23:10:12Z","timestamp":1727305812000},"page":"312-320","source":"Crossref","is-referenced-by-count":8,"title":["The Gastroscopy RAte of Cleanliness Evaluation (GRACE) Scale: an international reliability and validation study"],"prefix":"10.1055","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2242-5048","authenticated-orcid":false,"given":"Gianluca","family":"Esposito","sequence":"additional","affiliation":[{"name":"Department of Medical-Surgical Sciences and Translational Medicine, Sant\u2019Andrea Hospital, Sapienza University of Rome, Rome, Italy"}]},{"given":"Emanuele","family":"Dilaghi","sequence":"additional","affiliation":[{"name":"Department of Medical-Surgical Sciences and Translational Medicine, Sant\u2019Andrea Hospital, Sapienza University of Rome, Rome, Italy"}]},{"given":"Cristina","family":"Costa-Santos","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine of the University of Porto, Porto, Portugal"},{"name":"Center for Health Technology and Services Research \u2013 CINTESIS@RISE, Faculty of Medicine of the University of Porto, Porto, Portugal"}]},{"given":"Irene","family":"Ligato","sequence":"additional","affiliation":[{"name":"Department of Medical-Surgical Sciences and Translational Medicine, Sant\u2019Andrea Hospital, Sapienza University of Rome, Rome, Italy"}]},{"given":"Bruno","family":"Annibale","sequence":"additional","affiliation":[{"name":"Department of Medical-Surgical Sciences and Translational Medicine, Sant\u2019Andrea Hospital, Sapienza University of Rome, Rome, Italy"}]},{"given":"M\u00e1rio","family":"Dinis-Ribeiro","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal"},{"name":"Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9787-8175","authenticated-orcid":false,"given":"Miguel","family":"Areia","sequence":"additional","affiliation":[{"name":"Francisco Gentil Portuguese Institute for Oncology of Coimbra, Gastroenterology Department, Portuguese Oncology Institute of Coimbra (IPO Coimbra), Coimbra, Portugal"},{"name":"RISE@CI-IPO (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal"}]},{"name":"GRACE 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