Interobserver Variation of Bowel Preparation for Colonoscopy

Several bowel preparation scales have been developed, but they are variably validated to guide clinical practice. The aim of this study was to assess the interobserver reliability between internal and external endoscopists using the Harefield Cleaning Scale (HCS).

Data was collected from a study evaluating the efficacy of oral sulfate tablets in patients undergoing colonoscopy. The assessments of bowel cleansing were carried out by four internal endoscopists at the time of the procedure, and colonoscopy video recordings were reviewed independently by three external endoscopists. Interobserver reliability was quantified using Cohen's Kappa coefficient, and scores and grades of each segment were compared between internal and external endoscopist groups.

Among 83 colonoscopy videos, interobserver reliability yielded a fair agreement between internal and external endoscopists, with a Cohen's Kappa coefficient of 0.39 (95% CI 0.08-0.70). Successful overall preparation rates (100% vs 98.8%) and high-quality preparation rates (88% vs 94%) were excellent and comparable between the two groups. In contrast, one case of unsuccessful cleansing (grade C) was documented, only in the external group. In addition, the interobserver reliability between internal and external endoscopists comparing each segmental score yielded a slight agreement in the descending colon (0.11, 95% CI - 0.02 to 0.23) and sigmoid colon (0.04, 95% CI - 0.18 to 0.26).

Interobserver reliability between internal and external endoscopists using the HCS was fair. However, the HCS may be limited as a reliable scale for assessing bowel preparation quality in the left colon, where liquid is mainly retained in the left lateral position.