The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research

Abstract

Background Few bowel preparation rating scales have been validated. Most were intended for comparing oral purgatives, failing to account for washing/suctioning by the endoscopist. This limits their utility in studies of colonoscopy outcomes such as polyp detection rates. Objective To develop a valid and reliable scale for use in colonoscopy outcomes research. Setting Academic medical center. Methods We developed the Boston Bowel Preparation Scale (BBPS), a 10-point scale assessing bowel preparation after all cleansing maneuvers are completed by the endoscopist. We assessed inter- and intra-observer reliability using video footage of colonoscopies viewed on two separate occasions by 22 clinicians. We then applied the BBPS prospectively during screening colonoscopies, comparing BBPS scores with clinically-meaningful outcomes including polyp detection rates and procedure times. Results The intra-class correlation coefficient (a measure of inter-observer reliability) for BBPS scores was 0.74. The weighted Kappa (a measure of intra-observer reliability) for scores was 0.77 (95% CI 0.66-0.87). During 633 screening colonoscopies, the mean (SD) BBPS score was 6.0 (1.6). Higher BBPS scores (≥5 versus <5) were associated with a higher polyp detection rate (40% vs 24%; p<0.02). BBPS scores were inversely correlated with colonoscope insertion (r = −0.16; p<0.003) and withdrawal (r = −0.23; p<0.001) times. Limitations Single-center study. Conclusions The BBPS is a valid and reliable measure of bowel preparation. It may be well-suited to colonoscopy outcomes research because it reflects the colon's cleanliness during the inspection phase of the procedure.

Nutritional deficiency during colonoscopy preparation: the forgotten iatrogeny

“…The clinical indication for each procedure was collected from the written colonoscopy request protocol and bowel preparation quality was assessed by the endoscopist using the Boston Bowel Preparation Scale (BBPS) (13). The results of the intervention and all diagnostic and therapeutic procedures were also recorded for each patient.…”

Quality Assurance in Endoscopy: Which Parameters?

“…The Boston Bowel Preparation Scale is the most frequently used validated score [43,44]. It defines the cleanliness for 3 sections of the colon with 3 levels (0 = not prepared, 1 = only small parts of the mucosa visible; 2 = mucosa predominantly visible, 3 = mucosa clearly visible) so that the result is total scores of between 0 and 9.…”

Comparison of precancerous lesions detection between standard colonoscopy and novel balloon colonoscopy

“… Investigator will record bowel preparation using the Boston Bowel Preparation Scale Score method 15 . Total score (0-9) will be obtained by adding the scores for individual evaluation of right, mid and left colon.…”