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Hanzel J, Sey M, Ma C, Zou G, East JE, Siegel CA, Mosli M, Reinisch W, McDonald JWD, Silverberg MS, Van Viegen T, Shackelton LM, Clayton LB, Enns R, Epstein I, Hilsden RJ, Hookey L, Moffatt DC, Ng Kwet Shing R, Telford JJ, von Renteln D, Feagan BG, Barkun A, Jairath V. Existing Bowel Preparation Quality Scales Are Reliable in the Setting of Centralized Endoscopy Reading. Dig Dis Sci 2022; 68:1195-1207. [PMID: 36266592 DOI: 10.1007/s10620-022-07729-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/10/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Development of bowel preparation products has been based upon colon cleansing rating by a local endoscopist. It is unclear how bowel preparation scales perform when centrally evaluated. AIMS To evaluate the reliability of bowel preparation quality scales when assessed by central readers. METHODS Four central readers evaluated 52 videos in triplicate, 2 weeks apart, during the entire endoscopic procedure (insertion/withdrawal of the colonoscope) and exclusively on colonoscope withdrawal using the Boston Bowel Preparation Scale (BBPS), Chicago Bowel Preparation scale, Harefield Cleansing Scale, Ottawa Bowel Preparation Quality Scale (OBPQS), Aronchick score, a visual analogue scale, and additional items proposed in a modified Research and Development/University of California Los Angeles appropriateness process. Reliability was assessed with intraclass correlation coefficients. RESULTS Intraclass correlation coefficients (95% confidence interval) for inter-rater reliability of the quality scales ranged from 0.51 to 0.65 (consistent with moderate to substantial inter-rater reliability) during the entire procedure. Corresponding intraclass correlation coefficients for intra-rater reliability ranged from 0.69 to 0.77 (consistent with substantial intra-rater reliability). Reliability was highest in the right colon and lowest in the left colon. No differences were observed in reliability when assessed for the procedure overall (insertion/withdrawal) relative to assessment on withdrawal alone. CONCLUSION All five bowel preparation quality scales had moderate to substantial inter-rater reliability. Panelists considered the Aronchick score too simplistic for clinical trials and recognized that assessment of residual fluid in the Ottawa Bowel Preparation Quality Scale was not amenable to central assessment.
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Affiliation(s)
- Jurij Hanzel
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Faculty of Medicine, University of Ljubljana, University Medical Centre Ljubljana, Zaloška Cesta 7, 1000, Ljubljana, Slovenia.,Alimentiv Inc, 100 Dundas St Suite 200, London, ON, Canada
| | - Michael Sey
- Division of Gastroenterology, Department of Medicine, Western University & London Health Sciences Centre, University Hospital, 1151 Richmond St, Room A10-219, London, ON, Canada.,Lawson Health Research Institute, London Health Sciences Centre-Victoria Hospital, 800 Commissioners Rd E, London, ON, Canada
| | - Christopher Ma
- Alimentiv Inc, 100 Dundas St Suite 200, London, ON, Canada.,Division of Gastroenterology & Hepatology, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University Calgary, 2500 University Dr NW, Calgary, AB, Canada
| | - Guangyong Zou
- Department of Epidemiology and Biostatistics, Western University, 1151 Richmond St, London, ON, Canada
| | - James E East
- Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, OX1 2JD, UK.,Division of Gastroenterology and Hepatology, Mayo Clinic Healthcare, 15 Portland Pl, London, UK
| | - Corey A Siegel
- Section of Gastroenterology & Hepatology, Department of Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, USA
| | - Mahmoud Mosli
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, 22254, Saudi Arabia
| | - Walter Reinisch
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | | | - Mark S Silverberg
- Inflammatory Bowel Disease Centre, Mount Sinai Hospital, 600 University Ave, Toronto, ON, Canada
| | | | | | - Lucy B Clayton
- Norgine Ltd, Widewater Place Moorhall Road, Harefield, England, UK
| | - Robert Enns
- Division of Gastroenterology, Department of Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada
| | - Ian Epstein
- Division of Digestive Care & Endoscopy, Department of Medicine, Dalhousie University, 6299 South St, Halifax, NS, Canada
| | - Robert J Hilsden
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, 2500 University Dr NW, Calgary, AB, Canada.,Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, 3280 Hospital Dr NW, Calgary, AB, Canada
| | - Lawrence Hookey
- Gastrointestinal Diseases Research Unit, Department of Medicine, Queen's University, 99 University Ave, Kingston, ON, Canada
| | - Dana C Moffatt
- Department of Medicine, Max Rady College of Medicine, University of Manitoba, 66 Chancellors Cir, Winnipeg, Canada
| | | | - Jennifer J Telford
- Division of Gastroenterology, Department of Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada
| | - Daniel von Renteln
- Division of Gastroenterology, Department of Medicine, Université de Montréal, 2900 Edouard Montpetit Blvd, Montreal, QC, Canada
| | - Brian G Feagan
- Alimentiv Inc, 100 Dundas St Suite 200, London, ON, Canada.,Division of Gastroenterology, Department of Medicine, Western University & London Health Sciences Centre, University Hospital, 1151 Richmond St, Room A10-219, London, ON, Canada.,Department of Epidemiology and Biostatistics, Western University, 1151 Richmond St, London, ON, Canada
| | - Alan Barkun
- Division of Gastroenterology, McGill University and McGill University Health Centre, 845 Sherbrooke St W, Montreal, QC, Canada
| | - Vipul Jairath
- Alimentiv Inc, 100 Dundas St Suite 200, London, ON, Canada. .,Division of Gastroenterology, Department of Medicine, Western University & London Health Sciences Centre, University Hospital, 1151 Richmond St, Room A10-219, London, ON, Canada. .,Department of Epidemiology and Biostatistics, Western University, 1151 Richmond St, London, ON, Canada.
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