Bowel preparation quality scales for colonoscopy

Table 2 Reliability and validation data for bowel preparation scales

Scale	Study	Colons (n)	Raters (n)	Reliability	Validity
Aronchick	Aronchick[41], 2004	80	5	ICC values for: Total colon: 0.77 Cecum: 0.76 Distal colon: 0.31	NR
OBPS	Rostom et al[50], 2004	97	2	ICC values for: Right colon: 0.92 Mid colon: 0.88 Rectosigmoid colon: 0.89	Comparisons with Aronchick scale PCC: 0.89 OBPS vs 0.62 Aronchick ICC: 0.94 OBPS vs 0.77 Aronchick
	Chan et al[53], 2011	211	NR	NR	Cutoff scores for adequacy/inadequacy Optimal cutoff for inadequate ≥ 8: Sensitivity, 100%, specificity, 91%
	Martinato et al[54], 2013	150	NR	Ratings of physicians vs nurses: PCC: r = 0.60	Correlations with VAS PCC (physicians vs nurses): r = 0.60
	Lee et al[58], 2016	655	NA	NR	Comparison with BBPS for PDR and ADR PCC: r = -0.62 (P < 0.001); AUC of ROC analysis similar for PDR, ADR, right-sided adenomas, and SSAs
BBPS	Lai et al[47], 2009	633	22	ICC values: 0.74/0.77 wtd κ	PDR by score 40% for scores ≥ 5 vs 24% for scores < 5 (P < 0.02) Need for repeat CSP due to inadequate bowel prep 2% for scores ≥ 5 vs 73% for scores < 5 (P < 0.001) Correlation with colonoscope insertion time PCC: r = -0.16 (P < 0.003) Correlation with colonoscope withdrawal time PCC: r = -0.23 (P < 0.001)
	Calderwood et al[43], 2010	119	12	ICC values for: Total colon: 0.91 Right colon: 0.88 Transverse colon: 0.83 Left colon: 0.79	Correlations with ability to exclude polyps > 5 mm 100%, 88%, 82%, 33%, and 0% of physicians deemed bowel preparation adequate to exclude polyps > 5 mm at scores of ≥ 8, 7, 6, 5, and ≤ 4 respectively Correlations with surveillance recommendations after normal CSP Score < 5: 100% recommended ≤ 1 yr Scores 5-6: mean recommended interval 4.3 (± 3.9) yr Scores ≥ 7: 100% recommended 10 yr
	Calderwood et al[44], 2014	2516	74	NR	Physician-recommended CSP interval after negative CSP Scores ≥ 6 (≥ 2 each segment): 90% recommended 10 yr Scores 0-2: 96% recommended ≤ 1 yr
	Schindler et al[49], 2016	3	401	ICC values, all raters (all segment and total scores): 0.93	NR
	Gao et al[45], 2013	1012	13	ICC values: 0.987/0.671 wtd κ	PDR Scores ≥ 5 superior vs < 5 (35% vs 18%; P < 0.05)
	Kim et al[46], 2014	482	6	ICC values: Total colon: 0.90/0.63 wtd κ Right colon: 0.93/0.91 wtd κ Transverse colon: 0.88/0.86 wtd κ Left colon: 0.50/0.38 wtd κ	PDR Scores ≥ 8 superior vs scores < 8 (44.9% vs 33.0%; P = 0.04) Colonoscope withdrawal time PCC: r = -0.167 (P < 0.001) Colonoscope insertion time PCC: r = 0.018 (P = 0.695)
	Clark et al[57], 2016	438	4	ICC values by BBPS scores: 0 and 3: 1.0 2: 0.81 1: 0.80	ADR (> 5 mm) miss rates by BBPS score: 3: 5.6% 2: 5.2% 1: 15.9% Score of 2 noninferior to 3 for missed adenoma > 5 mm
HCS	Halphen et al[51], 2013	337	4	ICC value: 0.457 Test-retest κ values: Range, 0.33 to 0.85 Intrarater2: 0.28 to 0.64 Internal consistency3: 0.81, 0.86	Best score cutoff for satisfactory bowel preparation ≥ 2 for each segment: Sensitivity, 99% and specificity, 83% Correlation with Aronchick scale PCC: r = 0.833 AUC of ROC analysis (vs Aronchick scale scores) 0.945 for total colon
CBPS	Gerard et al[52], 2013	150	44	ICC values for: Range, 0.624 to 0.702 for all segments	Correlations of scores with adequate cleansing Adequate: Scores of 25-36 (≥ 95% of mucosa visualized) Inadequate: Scores of 0-24 (< 95% of mucosa visualized)

¹Raters included endoscopy nurses (n = 17), gastroenterology faculty (n = 14), and gastroenterology fellows (n = 9);

²Generalized κ for global agreement;

³Cronbach’s alpha;

⁴Raters included three gastroenterologists and one physician’s assistant. ADR: Adenoma detection rate; AUC: Area under the curve; BBPS: Boston Bowel Preparation Scale; CBPS: Chicago Bowel Preparation Scale; CSP: Colonoscopy; HCS: Harefield Cleansing Scale; ICC: Interobserver reliability kappa intraclass correlation coefficient; NA: Not applicable; NR: Not reported; OBPS: Ottawa Bowel Preparation Scale; PCC: Pearson correlation coefficient; PDR: Polyp detection rate; ROC: Receiver operating characteristic; SSA: Sessile serrated adenoma; VAS: Visual analogue scale; wtd: Weighted.