SMALL BOWEL CLEANSING ASSESSMENT AND REPORT (SB-CLEAR): STANDARDIZING THE REPORT OF BOWEL PREPARATION’S QUALITY IN CAPSULE ENDOSCOPY

Aims Small-bowel (SB) cleansing is crucial to assess reliability of capsule endoscopy (CE) findings. However, the existence of multiple grading scales for SB preparation in CE hampers their appliance in clinical practice. In 2020, Colon CLeansing Assessment and Report (CC-CLEAR) was created. We sought to validate an adapted version for evaluation of SB cleansing, aiming to standardize CE reporting regarding quality of preparation.

Methods For SB CLeansing Assessment and Report (SB-CLEAR), SB was divided into 3 tertiles, each being scored according to estimation of the percentage of visualized mucosa (0-<50%; 1-50-75%; 2->75%; 3->90%). Overall classification was a sum of each segment score, graded between excellent (8-9), good (6-7), and inadequate (0-5). Any segment scoring≤1 resulted in inadequate overall classification. CE videos were prospectively evaluated and scored by 2 experienced CE readers blinded to each other. Interobserver agreement was assessed.

Results We included 52 CEs. Overall, SB-CLEAR classifications were: reader A – 30(57.7%) excellent; 9(17.3%) good; 13(25.0%) inadequate; reader B – 33(63.5%) excellent; 6(11.5%) good; 13(25.0%) inadequate. SB-CLEAR inter-observer agreement was very strong for each tertile (first tertile r=0.863; second tertile r=0.865; third tertile r=0.861; p<0.001), which resulted in overall excellent correlation when considering all tertiles (r=0.940; p<0.001). By applying final classifications of “inadequate”, “good” and “excellent”, correlation was still very strong (r=0.857; p<0.001).

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Conclusions SB-CLEAR is an innovative and reproducible scale for evaluation of SB preparation quality in CE, with overall excellent inter-observer agreement. With CC-CLEAR, it may become a valuable tool to uniformize reporting of bowel preparation quality in CE.

Publication History

Article published online:
14 April 2022