Bowel cleansing quality evaluation in colon capsule endoscopy: what is the reference standard?

Area of Science:

• Gastroenterology
• Medical Imaging
• Endoscopy

Background:

• Diagnostic accuracy of colon capsule endoscopy (CCE) relies on optimal bowel preparation.
• Evaluating bowel cleansing quality is challenging due to significant interobserver variability.

Purpose of the Study:

• To establish an expert-driven agreement standard for bowel cleansing in CCE.
• To investigate the interobserver agreement on bowel cleansing quality using different scales.

Main Methods:

• An interobserver agreement study involving 24 readers with varying experience levels.
• Evaluation of 500 CCE images per reader using the Leighton-Rex and CC-CLEAR scales.
• Analysis of agreement using intraclass correlation coefficients (ICC).

Main Results:

• Expert agreement was achievable for poor and excellent cleansing, but not for intermediate grades.
• Good interobserver agreement (ICC 0.84) was observed for the Leighton-Rex scale.
• Moderate interobserver agreement (ICC 0.62) was found for the CC-CLEAR scale, regardless of reader experience.

Conclusions:

• The Leighton-Rex scale demonstrated better interobserver agreement than CC-CLEAR for CCE bowel cleansing.
• An expert-opinion standard for CCE cleansing quality could not be established.
• Dedicated training and potential AI calibration are suggested to improve cleansing evaluation consistency.