Subscribe to RSS
Clean Colon Software Program (CCSP), Proposal of a standardized Method to quantify Colon Cleansing During Colonoscopy: Preliminary Results
24 June 2015 (online)
Background and study aims: Neoplastic lesions can be missed during colonoscopy, especially when cleansing is inadequate. Bowel preparation scales have significant limitations and no objective and standardized method currently exists to establish colon cleanliness during colonoscopy. The aims of our study are to create a software algorithm that is able to analyze bowel cleansing during colonoscopies and to compare it to a validate bowel preparation scale.
Patients and methods: A software application (the Clean Colon Software Program, CCSP) was developed. Fifty colonoscopies were carried out and video-recorded. Each video was divided into 3 segments: cecum-hepatic flexure (1st Segment), hepatic flexure-descending colon (2nd Segment) and rectosigmoid segment (3rd Segment). Each segment was recorded twice, both before and after careful cleansing of the intestinal wall. A score from 0 (dirty) to 3 (clean) was then assigned by CCSP. All the videos were also viewed by four endoscopists and colon cleansing was established using the Boston Bowel Preparation Scale. Interclass correlation coefficient was then calculated between the endoscopists and the software.
Results: The cleansing score of the prelavage colonoscopies was 1.56 ± 0.52 and the postlavage one was 2,08 ± 0,59 (P < 0.001) showing an approximate 33.3 % improvement in cleansing after lavage. Right colon segment prelavage (0.99 ± 0.69) was dirtier than left colon segment prelavage (2.07 ± 0.71). The overall interobserver agreement between the average cleansing score for the 4 endoscopists and the software pre-cleansing was 0.87 (95 % CI, 0.84 – 0.90) and post-cleansing was 0.86 (95 % CI, 0.83 – 0.89).
Conclusions: The software is able to discriminate clean from non-clean colon tracts with high significance and is comparable to endoscopist evaluation.
- 1 Puckett J, Soop M. Optimizing colonoscopy preparation: the role of dosage, timing and diet. Curr Opin Clin Nutr Metab Care 2012; 15: 499-504
- 2 Shaukat A, Mongin SJ, Geisser MS et al. Long-Term Mortality after Screening for Colorectal Cancer. N Engl J Med 2013; 369: 1106-1114
- 3 Singh H, Nugent Z, Demers AA et al. The reduction in colorectal cancer mortality after colonoscopy varies by site of the cancer. Gastroenterology 2010; 139: 1128-1137
- 4 Rex DK, Imperiale TF, Latinovich DR et al. Impact of bowel preparation on efficiency and cost of colonoscopy. Am J Gastroenterol 2002; 97: 1696-1700
- 5 Aronchick CA, Lipshutz WH, Wright SH et al. Validation of an instrument to assess colon cleansing. [abstract]. Am J Gastroenterol 1999; 94: 2667
- 6 Rostom A, Jolicoeur E. Validation of a new scale for the assessment of bowel preparation quality. Gastrointest Endosc 2004; 59: 482-486
- 7 Calderwood AH, Jacobson BC. Comprehensive validation of the Boston Bowel Preparation Scale. Gastrointest Endosc 2010; 72: 686-692
- 8 Halphen M, Hershback D, Gruss HJ et al. Validation of the Harefield Cleansing Scale: a tool for the evaluation of bowel cleansing quality in both research and clinical practice. Gastrointest Endosc 2013; 78: 121-131
- 9 Gerard DP, Foster DB, Raiser MW et al. Validation of a New Bowel Preparation Scale for Measuring Colon Cleansing for Colonoscopy: The Chicago Bowel Preparation Scale. Clin Transl Gastroenterol 2013; 4: e43 DOI: 10.1038/ctg.2013.16.
- 10 Hassan C, Bretthauer M, Kaminski MF et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy ESGE) Guideline. Endoscopy 2013; 45: 142-150
- 11 Shrout PE, Fleiss JL. Interclass correlations: uses in assessing rater reliability. Psychol Bull 1979; 86: 420-428
- 12 Altman DG. Statistics for medical research. Chapman & Hall/CRC press; 1990
- 13 Soetikno RM, Kaltenbach T, Rouse RV et al. Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults. JAMA 2008; 299: 1027-1035
- 14 Kahi CJ, Hewett DG, Norton DL et al. Prevalence and variable detection of proximal colon serrated polyps during screening colonoscopy. Clin Gastroenterol Hepatol 2011; 9: 42-46
- 15 Brenner H, Chang-Claude J, Seiler CM et al. Interval cancers after negative colonoscopy: population-based case-control study. Gut 2012; 61: 1576-1582
- 16 Koskela E, Kulju T, Collan Y. Melanosis coli. Prevalence, distribution, and histologic features in 200 consecutive autopsies at Kuopio University Central Hospital. Dis Colon Rectum 1989; 32: 235-239