The Colon Endoscopic Bubble Scale (CEBuS): a two-phase evaluation study

Abstract

Background To date, no scale has been validated to assess bubbles associated with bowel preparation. This study aimed to develop and assess the reliability of a novel scale – the Colon Endoscopic Bubble Scale (CEBuS).

Methods This was a multicenter, prospective, observational study with two online evaluation phases of 45 randomly distributed still colonoscopy images (15 per scale grade). Observers assessed images twice, 2 weeks apart, using CEBuS (CEBuS-0 – no or minimal bubbles, covering < 5 % of the surface; CEBuS-1 – bubbles covering 5 %–50 %; CEBuS-2 – bubbles covering > 50 %) and reporting the clinical action (do nothing; wash with water; wash with simethicone).

Results CEBuS provided high levels of agreement both in evaluation Phase 1 (4 experts) and Phase 2 (6 experts and 13 non-experts), with almost perfect intraobserver reliability: kappa 0.82 (95 % confidence interval 0.75–0.88) and 0.86 (0.85–0.88); interobserver agreement – intraclass correlation coefficient (ICC) 0.83 (0.73–0.89) and 0.90 (0.86–0.94). Previous endoscopic experience had no influence on agreement among experts vs. non-experts: kappa 0.86 (0.80–0.91) vs. 0.87 (0.84–0.89) and ICC 0.91 (0.87–0.94) vs. 0.90 (0.86–0.94), respectively. Interobserver agreement on clinical action was ICC 0.63 (0.43–0.78) in Phase 1 and 0.77 (0.68–0.84) in Phase 2. Absolute agreement on clinical action per scale grade was 85 % (82–88) for CEBuS-0, 21 % (16–26) for CEBuS-1, and 74 % (70–78) for CEBuS-2.

Conclusion CEBuS proved to be a reliable instrument to standardize the evaluation of colonic bubbles during colonoscopy. Assessment in daily practice is warranted.

Publication History

Received: 22 May 2020

Accepted after revision: 07 December 2020

Accepted Manuscript online:
07 December 2020

Article published online:
12 February 2021

• References

• 1 Hassan C, Fuccio L, Bruno M. et al. A predictive model identifies patients most likely to have inadequate bowel preparation for colonoscopy. Clin Gastroenterol Hepatol 2012; 10: 501-506
• 2 Kaminski MF, Thomas-Gibson S, Bugajski M. et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2017; 49: 378-397
• 3 Yoo IK, Jeen YT, Kang SH. et al. Improving of bowel cleansing effect for polyethylene glycol with ascorbic acid using simethicone: a randomized controlled trial. Medicine (Baltimore) 2016; 95: e4163
• 4 Matro R, Tupchong K, Daskalakis C. et al. The effect on colon visualization during colonoscopy of the addition of simethicone to polyethylene glycol-electrolyte solution: a randomized single-blind study. Clin Transl Gastroenterol 2012; 3: e26
• 5 Pan P, Zhao SB, Li BH. et al. Effect of supplemental simethicone for bowel preparation on adenoma detection during colonoscopy: a meta-analysis of randomized controlled trials. J Gastroenterol Hepatol 2019; 34: 314-320
• 6 Hassan C, East J, Radaelli F. et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019. Endoscopy 2019; 51: 775-794
• 7 Calderwood AH, Jacobson BC. Comprehensive validation of the Boston Bowel Preparation Scale. Gastrointest Endosc 2010; 72: 686-692
• 8 Jolicoeur R. Validation of a new scale for the assessment of bowel preparation quality. Gastrointest Endosc 2004; 59: 482-486
• 9 Aronchick CA, Lipshutz WH, Wright SH. et al. A novel tableted purgative for colonoscopic preparation: efficacy and safety comparisons with Colyte and Fleet Phospho-Soda. Gastrointest Endosc 2000; 52: 346-352
• 10 Spada C, Cesaro P, Bazzoli F. et al. Evaluation of Clensia⁽, a new low-volume PEG bowel preparation in colonoscopy: multicentre randomized controlled trial versus 4L PEG. Dig Liver Dis 2017; 49: 651-656
• 11 Repici A, Cestari R, Annese V. et al. Randomised clinical trial: low-volume bowel preparation for colonoscopy – a comparison between two different PEG-based formulations. Aliment Pharmacol Ther 2012; 36: 717-724
• 12 Guo R, Wang YJ, Liu M. et al. The effect of quality of segmental bowel preparation on adenoma detection rate. BMC Gastroenterol 2019; 19: 119
• 13 Zhang S, Zheng D, Wang J. et al. Simethicone improves bowel cleansing with low-volume polyethylene glycol: a multicenter randomized trial. Endoscopy 2018; 50: 412-422
• 14 Rishi M, Kaur J, Ulanja M. et al. Randomized, double-blinded, placebo-controlled trial evaluating simethicone pretreatment with bowel preparation during colonoscopy. World J Gastrointest Endosc 2019; 11: 413-423
• 15 Moraveji S, Casner N, Bashashati M. et al. The role of oral simethicone on the adenoma detection rate and other quality indicators of screening colonoscopy: a randomized, controlled, observer-blinded clinical trial. Gastrointest Endosc 2019; 90: 141-149
• 16 Hripcsak G, Heitjan DF. Measuring agreement in medical informatics reliability studies. J Biomed Informatics 2002; 35: 99-110
• 17 Fleiss JL, Cohen J. The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability. Educ Psychol Meas 2016; 33: 613-619
• 18 Yeh JH, Hsu MH, Tseng CM. et al. The benefit of adding oral simethicone in bowel preparation regimen for the detection of colon adenoma: a systematic review and meta-analysis. J Gastroenterol Hepatol 2019; 34: 830-836
• 19 Moolla M, Dang JT, Shaw A. et al. Simethicone decreases bloating and improves bowel preparation effectiveness: a systematic review and meta-analysis. Surg Endosc 2019; 33: 3899-3909
• 20 Sudduth RH, DeAngelis S, Sherman KE. et al. The effectiveness of simethicone in improving visibility during colonoscopy when given with a sodium phosphate solution: a double-bind randomized study. Gastrointest Endosc 1995; 42: 413-415
• 21 Beilenhoff U, Biering H, Blum R. et al. Reprocessing of flexible endoscopes and endoscopic accessories used in gastrointestinal endoscopy: position statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology Nurses and Associates (ESGENA) – Update 2018. Endoscopy 2018; 50: 1205-1234
• 22 Li DF, Luo MH, Du QQ. et al. Efficacy of low-dose versus high-dose simethicone with polyethylene glycol for bowel preparation: a prospective randomized controlled trial. J Gastroenterol Hepatol 2020; 35: 1488-1494
• 23 Zhou J, Wu L, Wan X. et al. A novel artificial intelligence system for the assessment of bowel preparation (with video). Gastrointest Endosc 2020; 91: 428-435 e422