Original article
Clinical endoscopy
Comprehensive validation of the Boston Bowel Preparation Scale

Presented in part at Digestive Disease Week, May 30-June 4, 2009, Chicago, Illinois (Gastrointest Endosc 2009;69:AB273-4).
https://doi.org/10.1016/j.gie.2010.06.068Get rights and content

Background

The Boston Bowel Preparation Scale (BBPS) is a novel bowel cleanliness rating scale that has undergone partial validation previously.

Objective

To fully validate the BBPS and assess the ease of its dissemination.

Design

Observational study.

Setting

Various endoscopy units worldwide.

Subjects

Endoscopists.

Methods

Video recordings of colonoscopies with varying degrees of cleanliness were viewed twice by gastroenterologists at 1 medical center. For each video, participants assigned segment and total BBPS scores. Endoscopists worldwide were also surveyed about their experience with the BBPS after viewing an instructional video.

Main Outcome Measurements

Intraclass correlation coefficients and weighted κ values assessed inter- and intrarater reliability, respectively. The BBPS was used among 983 patients undergoing screening colonoscopy.

Results

The BBPS demonstrated near-perfect interrater reliability (intraclass correlation coefficient = 0.91) and substantial intrarater reliability (weighted κ = 0.78; 95% CI, 0.73-0.84). Among 983 colonoscopies, right and left colon segment scores of 2 or 3 had a multivariate odds ratio of 1.60 (95% CI, 1.01-2.55) and 2.58 (95% CI, 1.34-4.98), respectively, for polyp detection compared with segment scores of 0 or 1. Endoscopists from a variety of settings worldwide found the BBPS easy to implement and applicable to their patient population.

Limitations

Single-center reliability testing.

Conclusions

The BBPS is a valid and reliable instrument for assessing bowel cleanliness during colonoscopy. Segment scores may represent a standardized way to determine bowel preparation adequacy. The BBPS can be easily disseminated through the use of a brief instructional video.

Section snippets

Methods

The study was approved by the Institutional Review Board of the Boston University Medical Center (BUMC) with waiver of informed consent.

Reliability testing

The BP-DVDs were viewed by 9 full-time faculty and 3 fellows at BUMC. Previous work showed that the BBPS can be used reliably by clinicians with various levels of experience with similar inter- and intrarater reliability,8 and therefore results for all 12 participants were analyzed and reported together. Some of the participants had been introduced to the BBPS during a previous research study,8 but the scale was not being used routinely for rating bowel preparation quality. Individuals viewed a

Discussion

In this study, we further established the validity and reliability of the BBPS as an instrument for assessing bowel cleanliness during colonoscopy for both research and clinical purposes. We also demonstrated that the BBPS can be easily disseminated to a wide range of practice locations worldwide by using a simple online video. Total BBPS scores demonstrated strong inter- and intrarater reliability over the full range of possible scores and bowel cleanliness. Total BBPS scores were associated

Acknowledgment

We acknowledge the efforts of our colleagues at BUMC who reviewed the BP-DVDs as well as the national and international clinicians who responded to our survey.

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DISCLOSURE: Supported by an ASGE/TAP Endoscopic Research Award (Dr. Jacobson) and National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases awardK08-DK070706 (Dr. Jacobson). The authors disclosed no financial relationships relevant to this publication.

If you would like to chat with an author of this article, you may contact Dr. Calderwood at [email protected].

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