Filipe Taveira1, Cesare Hassan2, Michal F Kaminski3,4,5,6, Thierry Ponchon7, Robert Benamouzig8, Marek Bugajski3,4, Flore de Castelbajac8, Paola Cesaro9, Hasnae Chergui8, Loredana Goran10, Leonardo Minelli Grazioli9, Martin Janičko11, Wladyslaw Januszewicz3,4, Laura Lamonaca12, Jamila Lenz7, Lucian Negreanu10, Alessandro Repici12, Cristiano Spada9,13, Marco Spadaccini12, Monica State10, Jakub Szlak3, Eduard Veseliny11, Mário Dinis-Ribeiro14,15, Miguel Areia1,14. 1. Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal. 2. Gastroenterology and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy. 3. Department of Gastroenterological Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland. 4. Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Warsaw, Poland. 5. Department of Cancer Prevention, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland. 6. Department of Health Management and Health Economics, University of Oslo, Oslo, Norway. 7. Department of Hepatogastroenterology, Hôpital Edouard Herriot, Lyon, France. 8. Service de Gastroentérologie, Hôpital Avicenne (APHP), Bobigny, France. 9. Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy. 10. Department of Gastroenterology, University Hospital, 'Carol Davila' University Bucharest, Romania. 11. 2nd Department of Internal Medicine, Pavol Jozef Šafárik University, Košice, Slovakia. 12. Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS -, Rozzano, Lombardia, Italy. 13. Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy. 14. Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal. 15. Gastroenterology Department, Portuguese Oncology Institute of Porto, Portugal.
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. Thieme. All rights reserved.
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. Thieme. All rights reserved.
Authors: Milena Di Leo; Andrea Iannone; Monica Arena; Giuseppe Losurdo; Maria Angela Palamara; Giuseppe Iabichino; Pierluigi Consolo; Maria Rendina; Carmelo Luigiano; Alfredo Di Leo Journal: World J Gastroenterol Date: 2021-12-07 Impact factor: 5.742