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. 2015 Oct;3(5):E501-7.
doi: 10.1055/s-0034-1392109. Epub 2015 Jun 24.

Clean Colon Software Program (CCSP), Proposal of a standardized Method to quantify Colon Cleansing During Colonoscopy: Preliminary Results

Erik Rosa-Rizzotto  1 , Adrian Dupuis  2 , Ennio Guido  1 , Diego Caroli  3 , Fabio Monica  4 , Daniele Canova  4 , Erica Cervellin  5 , Renato Marin  5 , Cristina Trovato  6 , Cristiano Crosta  6 , Silvia Cocchio  7 , Vincenzo Baldo  7 , Franca De Lazzari  1
Affiliations

Clean Colon Software Program (CCSP), Proposal of a standardized Method to quantify Colon Cleansing During Colonoscopy: Preliminary Results

Erik Rosa-Rizzotto et al. Endosc Int Open. 2015 Oct.

Abstract

Background and study aims: Neoplastic lesions can be missed during colonoscopy, especially when cleansing is inadequate. Bowel preparation scales have significant limitations and no objective and standardized method currently exists to establish colon cleanliness during colonoscopy. The aims of our study are to create a software algorithm that is able to analyze bowel cleansing during colonoscopies and to compare it to a validate bowel preparation scale.

Patients and methods: A software application (the Clean Colon Software Program, CCSP) was developed. Fifty colonoscopies were carried out and video-recorded. Each video was divided into 3 segments: cecum-hepatic flexure (1st Segment), hepatic flexure-descending colon (2nd Segment) and rectosigmoid segment (3rd Segment). Each segment was recorded twice, both before and after careful cleansing of the intestinal wall. A score from 0 (dirty) to 3 (clean) was then assigned by CCSP. All the videos were also viewed by four endoscopists and colon cleansing was established using the Boston Bowel Preparation Scale. Interclass correlation coefficient was then calculated between the endoscopists and the software.

Results: The cleansing score of the prelavage colonoscopies was 1.56 ± 0.52 and the postlavage one was 2,08 ± 0,59 (P < 0.001) showing an approximate 33.3 % improvement in cleansing after lavage. Right colon segment prelavage (0.99 ± 0.69) was dirtier than left colon segment prelavage (2.07 ± 0.71). The overall interobserver agreement between the average cleansing score for the 4 endoscopists and the software pre-cleansing was 0.87 (95 % CI, 0.84 - 0.90) and post-cleansing was 0.86 (95 % CI, 0.83 - 0.89).

Conclusions: The software is able to discriminate clean from non-clean colon tracts with high significance and is comparable to endoscopist evaluation.

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Conflict of interest statement

Competing interests: None

Figures

Fig. 1
Fig. 1
Flowchart of the software program
Fig. 2
Fig. 2
Colon Cleansing Level. At left is the original frame and at right is the elaborated image with white pixel “dirty” areas and DRRI corresponding index.
Fig. 3
Fig. 3
Elaboration Data. The mean colon cleansing level is calculated by the elaboration of all frames.
Fig. 4
Fig. 4
Cleanliness of each colonoscopy divided by segment
Fig. 5
Fig. 5
Total number of videos for all endoscopists and CCSP subdivided by cleansing score and colon segment
See this image and copyright information in PMC

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