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.
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.


METHODS
Prospective, randomized, single-center study.


METHODS
Tertiary university hospital.


METHODS
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.


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


METHODS
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).


CONCLUSIONS
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.
Department of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.
Corey
C
Brotz
Neilanjan
N
Nandi
Mitchell
M
Conn
Constantine
C
Daskalakis
Michael
M
DiMarino
Anthony
A
Infantolino
Leo C
LC
Katz
Theodore
T
Schroeder
David
D
Kastenberg
D053704:Capsule Endoscopy; D005260:Female; D006801:Humans; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D007507:Therapeutic Irrigation / Q000379:methods*