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Performance of bowel preparation quality scales in patients with Crohn's disease
Virginia Solitano1,2,3, Corey A Siegel4, Joshua R Korzenik5,6
1Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada.
Insights
Most instruments reliably assess bowel preparation quality in Crohn's disease patients. This supports their use in clinical practice and trials for new bowel preparation agents.
Area of Science:
- Gastroenterology
- Endoscopy
- Clinical Trials
Background:
- The effectiveness of bowel preparation (BP) in patients with Crohn's disease (CD) remains unestablished.
- Accurate assessment of BP quality is crucial for effective colonoscopy in CD patients.
Purpose of the Study:
- To evaluate the performance of various instruments used for assessing BP quality in patients with CD.
- To determine the reliability and validity of these instruments.
Main Methods:
- Utilized multiple scales: Boston Bowel Preparation Scale, modified Boston Bowel Preparation Scale, Harefield Cleansing Scale, Food and Drug Administration Bowel Cleansing Assessment Scale (BCAS), and a visual analogue scale.
- Assessed 50 videos from 40 CD patients, evaluating BP quality and endoscopic disease activity (Simple Endoscopic Score for CD - SES-CD).
- Quantified reliability using intraclass correlation coefficient (ICC) and validity through correlations between instruments and SES-CD scores.
Main Results:
- All instruments demonstrated substantial inter- and intra-rater reliability (ICC ≥0.61), with the visual analogue scale showing almost perfect intra-rater reliability (ICC ≥0.81).
- The Food and Drug Administration BCAS showed lower inter-rater reliability (ICC ≥0.41) on insertion.
- Validity correlations exceeded 0.58, and BP quality was negatively correlated with endoscopic disease activity in the colon.
Conclusions:
- Most current instruments reliably assess BP quality in CD patients.
- These findings support the use of these instruments in clinical practice and for scoring BP quality in CD clinical trials.
- The study provides a foundation for evaluating new BP agents in CD patients.
Background:
The performance of bowel preparation (BP) in patients with Crohn's disease (CD) is unknown.
Aims:
To evaluate the operating properties of instruments used to assess BP quality in patients with CD.
Methods:
We used the Boston Bowel Preparation Scale, modified Boston Bowel Preparation Scale, Harefield Cleansing Scale, Food and Drug Administration Bowel Cleansing Assessment Scale (BCAS), and a 100-mm visual analogue scale of bowel cleanliness to assess BP quality in 50 videos from 40 patients with CD. We assessed endoscopic activity with the Simple Endoscopic Score for CD (SES-CD). Assessments were on endoscope insertion and withdrawal. Reliability was quantified using the intraclass correlation coefficient (ICC). We assessed validity by within-patient correlation between instruments and the visual analogue scale using mixed-effect models. The correlation between BP quality and SES-SD scores was assessed using Spearman's rho.
Results:
Inter- and intra-rater reliability for all BP quality instruments was substantial (ICC ≥0.61) except for the Food and Drug Administration BCAS on insertion (inter-rater reliability ICC ≥0.41). The visual analogue scale had substantial inter- and almost perfect (ICC ≥0.81) intra-rater reliability. Correlation coefficients for the validity of the instruments exceeded 0.58. BP quality and endoscopic disease activity scores in the colon were negatively correlated.
Conclusion:
Most existing instruments reliably assess BP quality in patients with CD. These results support the use of these instruments in clinical practice, provide a framework for scoring BP quality in CD clinical trials, and support evaluation of novel BP agents in patients with CD.
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