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Colon Capsule CLEansing Assessment and Report (CC-CLEAR): a new approach for evaluation of the quality of bowel preparation in capsule colonoscopy

  • Rui de Sousa Magalhães
    Correspondence
    Reprint requests: Rui Magalhaes, Gastroenterology Department, Hospital da Senhora da Oliveira – Guimarães, Rua dos Cutileiros, Creixomil, Guimarães 4835-044, Portugal.
    Affiliations
    Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal

    Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal

    ICVS/3B’s, PT Government Associate Laboratory, Guimarães/Braga, Portugal
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  • Cátia Arieira
    Affiliations
    Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal

    Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal

    ICVS/3B’s, PT Government Associate Laboratory, Guimarães/Braga, Portugal
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  • Pedro Boal Carvalho
    Affiliations
    Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal

    Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal

    ICVS/3B’s, PT Government Associate Laboratory, Guimarães/Braga, Portugal
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  • Bruno Rosa
    Affiliations
    Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal

    Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal

    ICVS/3B’s, PT Government Associate Laboratory, Guimarães/Braga, Portugal
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  • Maria João Moreira
    Affiliations
    Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal

    Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal

    ICVS/3B’s, PT Government Associate Laboratory, Guimarães/Braga, Portugal
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  • José Cotter
    Affiliations
    Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal

    Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal

    ICVS/3B’s, PT Government Associate Laboratory, Guimarães/Braga, Portugal
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      Background and Aims

      Current colon capsule (CC) cleansing grading scales rely on subjective parameters and lack proper interobserver agreement. We should strive for higher intra- and interobserver agreement for the evaluation of the cleansing quality of CCs. Here we sought to validate a new grading scale for the evaluation of CC cleansing.

      Methods

      For the new grading scale, named Colon Capsule CLEansing Assessment and Report (CC-CLEAR), the colon was divided in 3 segments: right-sided, transverse, and left-sided colon. Each segment was scored according to an estimation of the percentage of visualized mucosa (0, <50%; 1, 50%-75%; 2, >75%; 3, >90%). The overall cleansing classification was a sum of each segment score, grading between excellent (8-9), good (6-7), and inadequate (0-5). Any segment scoring ≤1 resulted in inadequate overall classification. Videos were reviewed and scored using CC-CLEAR and the Leighton-Rex grading scale by 2 experienced operators blinded to each other. Kendall's coefficient evaluated inter- and intraobserver agreement.

      Results

      We included 58 consecutive CCs, corresponding to 75.9% women, with a mean age of 65 years. Overall cleansing CC-CLEAR classifications were as follows: reader A, 22.4% (n = 13) excellent, 31% (n = 18) good, and 46.5% (n = 27) inadequate; and reader B, 24.1% (n = 14) excellent, 22.4% (n = 13) good, and 53.4% (n = 31) inadequate. CC-CLEAR interobserver agreement was superior to the Leighton-Rex scale (Kendall’s W .911 vs .806, respectively; P < .01). The intraobserver agreement for CC-CLEAR was excellent for both readers (P > .01).

      Conclusions

      CC-CLEAR is a new practical and reliable grading scale for the evaluation of bowel preparation quality using a CC, with excellent inter- and intraobserver agreement.

      Graphical abstract

      Abbreviations:

      BBPS (Boston Bowel Preparation Scale), CC (colon capsule), CC-CLEAR (Colon Capsule CLEansing Assessment and Report)
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      References

        • Kastenberg D.
        • Bertiger G.
        • Brogadir S.
        Bowel preparation quality scales for colonoscopy.
        World J Gastroenterol. 2018; 24: 2833-2843
        • Heron V.
        • Parmar R.
        • Menard C.
        • et al.
        Validating bowel preparation scales.
        Endosc Int Open. 2017; 5: E1179-E1188
        • Sulz M.C.
        • Kroger A.
        • Prakash M.
        • et al.
        Meta-analysis of the effect of bowel preparation on adenoma detection: early adenomas affected stronger than advanced adenomas.
        PLoS One. 2016; 11e0154149
        • Johnson D.A.
        • Barkun A.N.
        • Cohen L.B.
        • et al.
        Optimizing adequacy of bowel cleansing for colonoscopy: recommendation from the US Multi-Society Task Force on Colorectal Cancer.
        Gastroenterology. 2014; 147: 903-924
        • Sharma R.S.
        • Rossos P.G.
        A review on the quality of colonoscopy reporting.
        Can J Gastroenterol Hepatol. 2016; 2016: 9423142
        • Leighton J.A.
        • Rex D.K.
        A grading scale to evaluate colon cleansing for the PillCam COLON capsule: a reliability study.
        Endoscopy. 2011; 43: 123-127
        • Boal Carvalho P.
        • Rosa B.
        • Dias de Castro F.
        • et al.
        PillCam COLON 2 in Crohn’s disease: a new concept of pan-enteric mucosal healing assessment.
        World J Gastroenterol. 2015; 21: 7233-7241
        • Rosa B.J.
        • Barbosa M.
        • Magalhães J.
        • et al.
        Oral purgative and simethicone before small bowel capsule endoscopy.
        World J Gastrointest Endosc. 2013; 5: 67-73
        • Cotter J.
        • Magalhaes J.
        • de Castro F.D.
        • et al.
        Virtual chromoendoscopy in small bowel capsule endoscopy: new light or a cast of shadow?.
        World J Gastrointest Endosc. 2014; 6: 359-365
        • Cotter J.
        • Magalhaes J.
        • Dias de Castro F.
        • et al.
        Finding the solution for incomplete small bowel capsule endoscopy.
        World J Gastrointest Endosc. 2013; 5: 595-599
        • Carvalho P.B.
        • Rosa B.
        • Cotter J.
        Mucosal healing in Crohn's disease—Are we reaching as far as possible with capsule endoscopy?.
        J Crohns Colitis. 2014; 8: 1566-1567
        • Enns R.A.H.L.
        • Hookey L.
        • Armstrong D.
        • et al.
        Clinical practice guidelines for the use of video capsule endoscopy.
        Gastroenterology. 2017; 152: 497-514
        • Evans J.D.
        Straightforward statistics for the behavioral sciences.
        Brooks/Cole Publishing, Pacific Grove, CA1996
        • Kastenberg D.
        • Burch Jr., W.C.
        • Romeo D.P.
        • et al.
        Multicenter, randomized study to optimize bowel preparation for colon capsule endoscopy.
        World J Gastroenterol. 2017; 23: 8615-8625
        • Spada C.
        • Hassan C.
        • Galmiche J.P.
        • et al.
        Colon capsule endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline.
        Endoscopy. 2012; 44: 527-536
        • Pasha S.F.
        Applications of colon capsule endoscopy.
        Curr Gastroenterol Rep. 2018; 20: 22
        • Baltes P.
        • Bota M.
        • Albert J.
        • et al.
        PillCamColon2 after incomplete colonoscopy—a prospective multicenter study.
        World J Gastroenterol. 2018; 24: 3556-3566
        • Buijs M.M.
        • Kroijer R.
        • Kobaek-Larsen M.
        • et al.
        Intra and inter-observer agreement on polyp detection in colon capsule endoscopy evaluations.
        United Eur Gastroenterol J. 2018; 6: 1563-1568
        • Lai E.J.
        • Calderwood A.H.
        • Doros G.
        • et al.
        The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research.
        Gastrointest Endosc. 2009; 69: 620-625
        • Kluge M.A.
        • Williams J.L.
        • Wu C.K.
        • et al.
        Inadequate Boston Bowel Preparation Scale scores predict the risk of missed neoplasia on the next colonoscopy.
        Gastrointest Endosc. 2018; 87: 744-751
        • Massinha P.
        • Almeida N.
        • Cunha I.
        • et al.
        Clinical practice impact of the Boston Bowel Preparation Scale in a European country.
        GE Port J Gastroenterol. 2018; 25: 230-235
        • Ponte A.
        • Pinho R.
        • Rodrigues A.
        • et al.
        Review of small-bowel cleansing scales in capsule endoscopy: a panoply of choices.
        World J Gastrointest Endosc. 2016; 8: 600-609
        • Brotz C.
        • Nandi N.
        • Conn M.
        • et al.
        A validation study of 3 grading systems to evaluate small-bowel cleansing for wireless capsule endoscopy: a quantitative index, a qualitative evaluation, and an overall adequacy assessment.
        Gastrointest Endosc. 2009; 69: 262-270
        • Park S.C.
        • Keum B.
        • Hyun J.J.
        • et al.
        A novel cleansing score system for capsule endoscopy.
        World J Gastroenterol. 2010; 16: 875-880
        • Spada C.
        • McNamara D.
        • Despott E.J.
        • et al.
        Performance measures for small-bowel endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative.
        Endoscopy. 2019; 51: 574-598
        • Bouchard S.
        • Ibrahim M.
        • Van Gossum A.
        Video capsule endoscopy: perspectives of a revolutionary technique.
        World J Gastroenterol. 2014; 20: 17330-17344