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
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.
Il testo completo di questo articolo è disponibile in PDF.Abbreviations : CE, DQE, ICC, OAA, OR, QE, QI, TIMI, TJUH
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| 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. |
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| If you want to chat with an author of this article, you may contact him at david.kastenberg@jefferson.edu. |
Vol 69 - N° 2
P. 262 - febbraio 2009 Ritorno al numero
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