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Global assessment of the PEACE scale for upper GI cleanliness

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Created On: 02/05/2025

A high-quality esophagogastroduodenoscopy (EGD) requires proper mucosal cleanliness.

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Key take away

PEACE scale demonstrated strong interobserver agreement among expert international endoscopists for upper gastrointestinal tract cleanliness, requiring minimal training and supporting its broad clinical application.

Background

A high-quality esophagogastroduodenoscopy (EGD) requires proper mucosal cleanliness. The objective of this research was to confirm the validity of the Polprep: Effective Assessment of Cleanliness in EGD (PEACE) scale among endoscopists from around the world.

Method

Overall, 39 EGD videos showcasing varying levels of mucosal cleanliness were collected from a prior prospective trial. Experts evaluated the mucosal cleanliness for each video using the PEACE scale, and the agreement of scores (0-3) was analyzed with the intraclass correlation coefficient (ICC) 2.1. The kappa values were utilized to assess the level of agreement on sufficient (scores 2 and 3) versus insufficient (scores 0 and 1) cleanliness.

Result

Sixteen endoscopists reviewed videos assessing the cleanliness of the esophagus, stomach, and duodenum. The PEACE scores showed strong agreement (intraclass correlation coefficient 0.82, 95% confidence interval [CI] 0.75-0.89), with a higher agreement for the esophagus (0.84; 95% CI 0.71-0.95) and stomach (0.81; 95% CI 0.69-0.91), while the duodenum had moderate agreement (0.69; 95% CI 0.51-0.87).

The agreement was similar among Eastern and Western experts, as well as for adequate cleanliness, with Eastern and Western endoscopists displaying consistent agreement overall (0.75; 95% CI 0.65-0.85).

Conclusion

The PEACE scoring system is a validated tool for assessing mucosal cleanliness during EGD, showing high agreement among experts and supporting its clinical use.