title: Validated computed cleansing score for video capsule endoscopy.
abstract: OBJECTIVE
  Diagnostic yield of video capsule endoscopy may be hampered by intestinal content or air bubbles. A major limitation in video capsule-related study is the lack of a validated objective score for bowel preparation quality. We aimed to design and validate a computed small bowel preparation score for research and clinical use.
  
  
  METHODS
  Two experienced physicians reached a consensus regarding bowel preparation quality based on known criteria used in previous studies and their confidence of an accurate medical interpretation of the procedure. A computed algorithm based on the pixels in the color bar was created and validated. Concordance between the gastroenterologists' agreement (gold standard) and the computed analysis was assessed.
  
  
  RESULTS
  Of 85 videos studied, 44 (52%), 13 (15%) and 28 (33%) had adequate, borderline and inadequate bowel preparation, respectively, according to the gastroenterologists' agreement. Computer analysis restricted to adequate and inadequate cases yielded accurate classification of bowel preparation in 65/72 cases (90% agreement, sensitivity 95%, specificity 82%, total accuracy 90%, Kappa 0.79). When adding the borderline definition, the computer analysis correctly classified 71/85 of the cases, yielding an overall agreement of 84% (Kappa 0.72). Minute-by-minute analysis of 10 cases also yielded an agreement of 91.4%.
  
  
  CONCLUSIONS
  The present study introduces a user-friendly computer analysis-based small bowel preparation score, which demonstrated excellent concordance with the physician's assessment. This score holds promise as a standardization tool in research and clinical practice of video capsule endoscopy. Further validation is warranted.
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.
authors.forename: Amir
authors.initials: A
authors.lastname: Klein
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.
authors.forename: Moshe
authors.initials: M
authors.lastname: Gizbar
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.|The University of Sydney, Sydney, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bourke
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.|The Westmead Millennium Institute for Medical Research, Sydney, Australia.
authors.forename: Golo
authors.initials: G
authors.lastname: Ahlenstiel
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D053704:Capsule Endoscopy; D002400:Cathartics; D015331:Cohort Studies; D003658:Decision Making, Computer-Assisted; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D015203:Reproducibility of Results
chemical_list: D002400:Cathartics
keywords: capsule endoscopy; cleansing score; diagnostic yield; polyethylene Glycol; small bowel