Validating bowel preparation scales

Abstract

Background and study aim Few scales assessing bowel preparation quality have been validated, and direct between-scale comparisons remain scarce. The aim of the study was to compare inter- and intra-rater reliability, predictive abilities for clinical outcomes, and ease of use for each scale. Methods Colonoscopy video recordings highlighting five colonic segments after washing were viewed independently by three physicians, and cleanliness was evaluated using the Boston Bowel Preparation Scale (BBPS), the Chicago Bowel Preparation Scale (CBPS), and the Harefield Cleansing Scale (HCS) in randomized order. Kappa or intraclass correlations quantified intra- and inter-rater reliability. Ease of use was evaluated (1 – 10 scale, 1 = easy), as were associations between scores, adenoma detection, and adequacy of preparation to exclude lesions ≥ 5 mm. Results Among 83 colonoscopy videos, indications included screening or surveillance in 72.3 %. Mean (± SD) scores of the respective three raters were 5.17 ± 1.57, 6.49 ± 1.48, and 5.12 ± 1.21 for BBPS, and 23.73 ± 6.01, 28.39 ± 5.47, and 24.75 ± 5.83 for CBPS, while successful HCS scores (grade A or B) were given for 76 %, 89 %, and 63 % of examinations. Intra-rater reliability ranges were 0.88 – 1.00, 0.83 – 1.00, and 0.62 – 1.00 for BBPS, CBPS, and HCS, respectively. Similarly, inter-rater reliability ranges were 0.50 – 0.79, 0.64 – 0.83, and 0.28 – 0.52, respectively. Sources of disagreement included varying rater strictness, which was possibly most marked for preparations rated as intermediate. Overall, associations between preparation scores and adenoma detection lacked statistical significance. Conclusion The BBPS and CBPS showed the best inter- and intra-rater reliability, and the BBPS was considered the easiest to use. Further studies are needed to determine an optimal adequacy threshold for these scales, with the goal of predicting clinical outcomes and determining the appropriate interval to the next colonoscopy.

Improving the quality of bowel preparation through an app for inpatients undergoing colonoscopy: A randomized controlled trial

“…The demographic data included age, sex, history of colonoscopy, educational background, height, weight, consumption of a low‐residue diet within 24 hr before colonoscopy, physical exercise (taking a slow walk in the hallway for at least 30 min while taking the medication and after the medication), and time interval between the completion of the oral laxative therapy and colonoscopic examination. Bowel preparation quality was assessed by the BBPS, which is a validated tool for the assessment of colon cleansing quality (Heron, Parmar, Menard, Martel, & Barkun, ). Each of the three segments of the colon was scored from 0–3, where 0 represents a failed prepared colon segment with mucosa not visible and 3 represents successful preparation with the entire mucosa of the colon segment visible.…”

Split‐dose bowel preparation with polyethylene glycol for colonoscopy performed under propofol sedation. Is there an optimal timing?

“…We used a subjective scale driven by the Boston bowel preparation scale, as part of the Queensland bowel cancer screening program bowel preparation descriptors, which is considered to be one of the most discriminating and clinically relevant for routine clinical practice. 45 It does not include assessment of each segment of the colon separately, and subjective individual assessment by the endoscopist does not mandate the four-point scoring system.…”

Comparative efficacy of combination of 1 L polyethylene glycol, castor oil and ascorbic acid versus 2 L polyethylene glycol plus castor oil versus 3 L polyethylene glycol for colon cleansing before colonoscopy

“…The bowel preparation efficacy was regarded as the primary outcome, which will be assessed by using the Boston Bowel Preparation Scale (BBPS). As one of the commonest scales of assessing quality of bowel preparation, [ 29 ] the BBPS evaluates right (including the cecum and ascending colon), transverse (including the hepatic and splenic flexures), and left (including the descending colon, sigmoid colon, and rectum) colon on a 4-point scoring system with a total score out of 9. [ 30 ] In this scoring system, a score of 9 was summed if the whole colon was perfectly cleaned without any residual liquid, and a score of 0 was calculated if colonoscopy is impossible.…”