KODA score: an updated and validated bowel preparation scale for patients undergoing small bowel capsule endoscopy

Abstract

Background and study aims A reliable outcome measure is needed for bowel preparation quality during capsule endoscopy. Currently, no scales are adequately validated. Our objective was to update an existing small bowel preparation score, create a standardized training module, then determine its inter-rater and intra-rater reliability. Patients and methods Modification to produce standardized scoring of an existing small bowel preparation score was performed followed by development of a training module and validation to create the new Korea-Canada (KODA) score. Twenty readers from a range of backgrounds, including capsule endoscopists, gastroenterology fellows, residents, medical students, and nurses rated bowel cleanliness in 25 capsule videos consisting of 1,233 images, in duplicate 4 weeks apart, after completing the training module. Sequential images selected in 5-minute intervals during small bowel transit were rated on a scale between 0–3 based on the amount of visualized mucosa and the degree of obstruction. Reliability was assessed using estimates of intraclass correlation coefficients (ICCs). Results Intraclass correlation coefficients for inter-rater (ICC 0.81, 95 % CI 0.70–0.87) and intra-rater (ICC 0.92, 95 % CI 0.87–0.94) reliability were almost perfect among the 20 readers. Inter-rater reliability ranged between 0.72 (95 % CI 0.57–0.81) and 0.89 (95 % CI 0.79–0.93) for nurses and residents, respectively. Intra-rater reliability was greater than 0.90 for all groups except for nurses, which was still almost perfect (ICC 0.86, 95 % CI 0.79–0.90). Conclusions Almost perfect inter-rater and intra-rater reliability was observed for the KODA score. This simple score could be used for future clinical trials after completion of the training module.

A randomized controlled trial of high volume simethicone to improve visualization during capsule endoscopy

“…The primary strength of this study was the rigor in the design, including use of randomization, de facto masking, and centralized reading where adjudicators were blinded to treatment allocation and clinical information. In addition, we used a validated outcome measure with almost perfect inter and intra-rater reliabilities [ 24 ]. In contrast, prior studies [ 10 , 11 , 13 – 16 ] used un-validated and often ad hoc bowel preparation scales, which compromise their validity given their outcomes may change if assessed by a different individual (e.g.…”

“…Small bowel preparation quality was assessed using the KOrea-CanaDA (KODA) score, which we previously validated for use with capsule endoscopy with almost perfect inter-rater (ICC 0.81, 95% CI 0.70–0.87) and intra-rater reliabilities (ICC 0.92, 95%CI 0.87–0.94) among 20 readers of varying occupational backgrounds [ 24 ]. This score was utilized as there are no other validated bowel preparation score for the small intestine.…”

“…The primary outcome was adequate bowel preparation, defined as a KODA score >2.25 [ 24 ]. Secondary outcomes were: 1) Mean KODA score, for the total, proximal half, and distal half of the small intestine; 2) Diagnostic yield, defined as an angioectasia, polyp, tumor/mass, ulcer, Crohn’s disease, or stricture (small non-specific red spots of questionable significance were not considered diagnostic); 3) Study completion rate, defined as the capsule reaching the cecum; 4) Gastric transit time, defined as the time interval between the first gastric and first duodenal image; 5) Small intestinal transit time, defined as the time interval between the first duodenal and first cecal image.…”

Capsule Endoscopy in Children

“…Each image was scored on two parameters: visualized mucosa and the degree of the image obscured by debris, bubbles, and bile. Almost perfect inter-rater and intra-rater reliability was observed for what is to be known as the KODA score and can be used for clinical trials (68).…”

Comprehensive evaluation of a new automatic scoring system for cleanliness assessment in video capsule endoscopy

“…6 The most recent manual grading system for evaluating the sufficiency of small bowel preparation in VCE is called KODA score. 10 With the assistance of 20 health specialists, it has been scientifically validated on 1233 still frames taken from 25 capsule videos. Over each VCE procedure, still frames are taken every 5 min starting from the first picture of the duodenum and ending with the first picture of the cecum.…”