A validation study of 3 grading systems to evaluate small-bowel cleansing for wireless capsule endoscopy: a quantitative index, a qualitative evaluation, and an overall adequacy assessment - 23/08/11

Doi : 10.1016/j.gie.2008.04.016

Corey Brotz, MD, Neilanjan Nandi, MD, Mitchell Conn, MD, Constantine Daskalakis, ScD, Michael DiMarino, MD, Anthony Infantolino, MD, Leo C. Katz, MD, Theodore Schroeder, BS, David Kastenberg, MD ^⁎
Current affiliations: Department of Gastroenterology (C. B., M. C., M. D., A. I., L. K.), Department of Internal Medicine (N. N.), and Department of Biostatistics (C. D.), Thomas Jefferson University Hospital, and Thomas Jefferson Medical College (T. S.), Philadelphia, Pennsylvania, USA

Reprint requests: David Kastenberg, MD, Main Building, Suite 480, 132 S 10th St, Philadelphia, PA 19107.

Philadelphia, Pennsylvania, USA

Abstract

Background

Capsule endoscopy (CE) is a powerful tool for evaluating the small bowel. Assessment of small-bowel cleansing for CE is an essential quality measure.

Objective

Our purpose was to validate 3 new scales that grade small-bowel cleansing for CE.

Design

Prospective, randomized, single-center study.

Setting

Tertiary university hospital.

Intervention

Five experienced capsule endoscopists read 40 CEs twice, separated by 1 month, to grade small-bowel cleansing on 3 scales—quantitative index (QI; 0-10), qualitative evaluation (QE; poor, fair, good, excellent), and overall adequacy assessment (OAA; inadequate, adequate). The QI and QE evaluated both the entire and distal small bowel. Investigators received no prior training in these scales.

Main Outcome Measurements

Intraclass correlation coefficients to assess intraobserver (test-retest) and interobserver reliability.

Patients

Forty patients who underwent 1 CE between June 2005 and May 2006 and who satisfied entry criteria.

Results

Intraobserver reliability was moderate to substantial for the QI (0.60-0.66), moderate for the OAA (0.56), and fair to moderate for the QE (0.37-0.47). Interobserver scores were lower: QI and OAA moderate (0.47-0.52, 0.41, respectively) and slight to fair for the QE (0.20-0.24). QI scores for the entire and distal small bowel were highly correlated for each reader (0.57-0.87), and distal small-bowel scores were lower by 1.3 points, indicating poorer cleansing (P = .001). A dichotomized QE of excellent/good versus fair/poor had moderate to substantial intraobserver and interobserver reliability (0.58-0.66, 0.41-0.49, respectively). There was a strong and highly significant association among all 3 scales (P < .001 between QI and both QE and OAA).

Conclusion

We have described and validated 3 scales for grading small-bowel cleansing for CE. An evaluation of small-bowel cleansing should be routinely incorporated into the CE report.

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Abbreviations : CE, DQE, ICC, OAA, OR, QE, QI, TIMI, TJUH

Plan

Reliability of scoring systems

Relationship between scoring systems

Discussion

	DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: M. Conn, M. DiMarino: Speaker and consultant for Given Imaging, Ltd. A. Infantolino: Speakers bureau for Given Imaging, Ltd. All other authors disclosed no financial relationships relevant to this publication.
	If you want to chat with an author of this article, you may contact him at david.kastenberg@jefferson.edu.