The Boston Bowel Preparation Scale: A valid and reliable instrument for colonoscopy-oriented research

By E. J. Lai, Audrey H. Calderwood, G. Doros, O. Fix, B. Jacobson. Gastrointestinal Endoscopy, 2007

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Background Few bowel preparation rating scales have been validated. Most were intended for comparing oral purgatives, failing to account for washing/suctioning by the endoscopist. This limits their utility in studies of colonoscopy outcomes such as polyp detection rates. Objective To develop a valid and reliable scale for use in colonoscopy outcomes research. Setting Academic medical center. Methods We developed the Boston Bowel Preparation Scale (BBPS), a 10-point scale assessing bowel preparation after all cleansing maneuvers are completed by the endoscopist. We assessed inter- and intra-observer reliability using video footage of colonoscopies viewed on two separate occasions by 22 clinicians. We then applied the BBPS prospectively during screening colonoscopies, comparing BBPS scores with clinically-meaningful outcomes including polyp detection rates and procedure times. Results The intra-class correlation coefficient (a measure of inter-observer reliability) for BBPS scores was 0.74. The weighted Kappa (a measure of intra-observer reliability) for scores was 0.77 (95% CI 0.66-0.87). During 633 screening colonoscopies, the mean (SD) BBPS score was 6.0 (1.6). Higher BBPS scores (≥5 versus <5) were associated with a higher polyp detection rate (40% vs 24%; p<0.02). BBPS scores were inversely correlated with colonoscope insertion (r = −0.16; p<0.003) and withdrawal (r = −0.23; p<0.001) times. Limitations Single-center study. Conclusions The BBPS is a valid and reliable measure of bowel preparation. It may be well-suited to colonoscopy outcomes research because it reflects the colon's cleanliness during the inspection phase of the procedure.

Subfields: Microbiology, Oncology, Pulmonary and Respiratory Medicine

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