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.
Taveira, F., Hassan, C., Kaminski, M. F., Ponchon, T., Benamouzig, R., Bugajski, M., De Castelbajac, F., Cesaro, P., Chergui, H., Goran, L., Minelli Grazioli, L., Janicko, M., Januszewicz, W., Lamonaca, L., Lenz, J., Negreanu, L., Repici, A., Spada, C., Spadaccini, M., State, M., Szlak, J., Veseliny, E., Dinis-Ribeiro, M., Areia, M., The Colon Endoscopic Bubble Scale (CEBuS): A two-phase evaluation study, <<ENDOSCOPY>>, 2022; 54 (1): 45-51. [doi:10.1055/a-1331-4325] [https://hdl.handle.net/10807/250882]
The Colon Endoscopic Bubble Scale (CEBuS): A two-phase evaluation study
Hassan, Cesare;Cesaro, Paola;Spada, Cristiano;
2022
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.
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