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Observational Study
. 2014 Aug;80(2):269-76.
doi: 10.1016/j.gie.2014.01.031. Epub 2014 Mar 12.

Boston Bowel Preparation Scale scores provide a standardized definition of adequate for describing bowel cleanliness

Audrey H Calderwood  1 , Paul C Schroy 3rd  1 , David A Lieberman  2 , Judith R Logan  3 , Michael Zurfluh  2 , Brian C Jacobson  1
Affiliations
Observational Study

Boston Bowel Preparation Scale scores provide a standardized definition of adequate for describing bowel cleanliness

Audrey H Calderwood et al. Gastrointest Endosc. 2014 Aug.

Abstract

Background: Establishing a threshold of bowel cleanliness below which colonoscopies should be repeated at accelerated intervals is important, yet there are no standardized definitions for an adequate preparation.

Objective: To determine whether Boston Bowel Preparation Scale (BBPS) scores could serve as a standard definition of adequacy.

Design: Cross-sectional observational analysis of colonoscopy data from 36 adult GI endoscopy practices and prospective survey showing 4 standardized colonoscopy videos with varying degrees of bowel cleanliness.

Setting: The Clinical Outcomes Research Initiative.

Patients: Average-risk patients attending screening colonoscopy.

Interventions: Colonoscopy.

Main outcome measurements: Recommended follow-up intervals among average-risk, screening colonoscopies without polyps stratified by BBPS scores.

Results: We evaluated 2516 negative screening colonoscopies performed by 74 endoscopists. If the BBPS score was ≥2 in all 3 segments (N = 2295), follow-up was recommended in 10 years in 90% of cases. Examinations with total BBPS scores of 3 to 5 (N = 167) had variable recommendations. Follow-up within 1 year was recommended for 96% of examinations with total BBPS scores of 0 to 2 (N = 26). Similar results were noted among 167 participants in a video survey with pre-established BBPS scores.

Limitations: Retrospective study.

Conclusion: BBPS scores correlate with endoscopist behavior regarding follow-up intervals for colonoscopy. A total BBPS score ≥6 and/or all segment scores ≥2 provides a standardized definition of adequate for 10-year follow-up, whereas total scores ≤2 indicate that a procedure should be repeated within 1 year. Future work should focus on finding consensus for management of examinations with total scores of 3 to 5.

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Conflict of interest statement

Conflicts of Interests: D. Lieberman is the executive director of the Clinical Outcomes Research Initiative (CORI), a nonprofit organization supporting this study. This potential conflict of interest has been reviewed and managed by the Oregon Health & Science University and Veterans Affairs Conflict of Interest in Research Committee. The remaining authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Sample video case asking participants to provide a recommendation for timing of next colonoscopy based on bowel cleanliness observed.
Figure 2
Figure 2
Flow diagram showing the colonoscopy examinations included in the analysis of the association between Boston Bowel Preparation Scale scores and timing of the next colonoscopy recommended. * Recommendation for no further colonoscopies due to age
Figure 3
Figure 3
Percentage of normal colonoscopy examinations in which 10-year follow-up was recommended stratified by total Boston Bowel Preparation Scale score.
See this image and copyright information in PMC

References

    1. Froehlich F, Wietlisbach V, Gonvers JJ, et al. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study. Gastrointest Endosc. 2005;61:378–384. - PubMed
    1. Harewood GC, Sharma VK, de Garmo P. Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia. Gastrointest Endosc. 2003;58:76–79. - PubMed
    1. Lieberman D, Nadel M, Smith RA, et al. Standardized colonoscopy reporting and data system: report of the Quality Assurance Task Group of the National Colorectal Cancer Roundtable. Gastrointest Endosc. 2007;65:757–766. - PubMed
    1. Rex DK, Petrini JL, Baron TH, et al. Quality indicators for colonoscopy. Am J Gastroenterol. 2006;101:873–885. - PubMed
    1. Lieberman DA, Rex DK, Winawer SJ, et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012;143:844–857. - PubMed

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