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

• Published in: Gastrointestinal endoscopy Vol. 69; no. 2; pp. 262 - 270.e1
• Main Authors: Brotz, Corey, MD, Nandi, Neilanjan, MD, Conn, Mitchell, MD, Daskalakis, Constantine, ScD, DiMarino, Michael, MD, Infantolino, Anthony, MD, Katz, Leo C., MD, Schroeder, Theodore, BS, Kastenberg, David, MD
• Format: Journal Article
• Language: English
• Published: Maryland heights, MO Mosby, Inc 01.02.2009; Elsevier
• Subjects: Biological and medical sciences; Capsule Endoscopy; Digestive system. Abdomen; Endoscopy; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Intestine, Small; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Observer Variation; Prospective Studies; Therapeutic Irrigation - methods; thrombolysis in myocardial infarction; CE; OR; overall adequacy assessment; dichotomized qualitative evaluation; qualitative evaluation; ICC; odds ratio; capsule endoscopy; OAA; TJUH; quantitative index; QE; TIMI; QI; DQE; intraclass correlation coefficient; Thomas Jefferson University Hospital; Histopathology; Capsule endoscopy; Small intestine; Quantitative analysis
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2008.04.016

Background Capsule endoscopy (CE) is a powerful tool for evaluating the small bowel. Assessment of small-bowel cleansing for CE is an essential quality measure. Objective Our purpose was to validate 3 new scales that grade small-bowel cleansing for CE. Design Prospective, randomized, single-center study. Setting Tertiary university hospital. Intervention Five experienced capsule endoscopists read 40 CEs twice, separated by 1 month, to grade small-bowel cleansing on 3 scales—quantitative index (QI; 0-10), qualitative evaluation (QE; poor, fair, good, excellent), and overall adequacy assessment (OAA; inadequate, adequate). The QI and QE evaluated both the entire and distal small bowel. Investigators received no prior training in these scales. Main Outcome Measurements Intraclass correlation coefficients to assess intraobserver (test-retest) and interobserver reliability. Patients Forty patients who underwent 1 CE between June 2005 and May 2006 and who satisfied entry criteria. Results Intraobserver reliability was moderate to substantial for the QI (0.60-0.66), moderate for the OAA (0.56), and fair to moderate for the QE (0.37-0.47). Interobserver scores were lower: QI and OAA moderate (0.47-0.52, 0.41, respectively) and slight to fair for the QE (0.20-0.24). QI scores for the entire and distal small bowel were highly correlated for each reader (0.57-0.87), and distal small-bowel scores were lower by 1.3 points, indicating poorer cleansing ( P = .001). A dichotomized QE of excellent/good versus fair/poor had moderate to substantial intraobserver and interobserver reliability (0.58-0.66, 0.41-0.49, respectively). There was a strong and highly significant association among all 3 scales ( P < .001 between QI and both QE and OAA). Conclusion We have described and validated 3 scales for grading small-bowel cleansing for CE. An evaluation of small-bowel cleansing should be routinely incorporated into the CE report.