Endosc Int Open 2015; 03(05): E501-E507
DOI: 10.1055/s-0034-1392109
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Clean Colon Software Program (CCSP), Proposal of a standardized Method to quantify Colon Cleansing During Colonoscopy: Preliminary Results

Erik Rosa-Rizzotto
1  Dpt of Hospital and Territory, Gastroenterology Unit, St Anthony Hospital, Padua
,
Adrian Dupuis
2  Dpt of Medicine, Oncology Unit, San Donà di Piave, Venice
,
Ennio Guido
1  Dpt of Hospital and Territory, Gastroenterology Unit, St Anthony Hospital, Padua
,
Diego Caroli
3  Dpt of Medicine, Chioggia Hospital, Venice
,
Fabio Monica
4  Dpt of Medicine, Gastroenterology Unit, San Bassiano Hospital, Bassano del Grappa, Vicenza
,
Daniele Canova
4  Dpt of Medicine, Gastroenterology Unit, San Bassiano Hospital, Bassano del Grappa, Vicenza
,
Erica Cervellin
5  Dpt of Medicine, Endoscopy Unit, Dolo Hospital
,
Renato Marin
5  Dpt of Medicine, Endoscopy Unit, Dolo Hospital
,
Cristina Trovato
6  Division of Endoscopy, European Institute of Oncology, Milan
,
Cristiano Crosta
6  Division of Endoscopy, European Institute of Oncology, Milan
,
Silvia Cocchio
7  Dept. of Molecular Medicine, Laboratory of Public Health and Population Studies, University of Padua, Padua, Italy
,
Vincenzo Baldo
7  Dept. of Molecular Medicine, Laboratory of Public Health and Population Studies, University of Padua, Padua, Italy
,
Franca De Lazzari
1  Dpt of Hospital and Territory, Gastroenterology Unit, St Anthony Hospital, Padua
› Author Affiliations
Further Information

Publication History

Publication Date:
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.