A systematic review of existing bowel preparation scales for colonoscopy showed that the Boston bowel preparation scale is the most user-friendly and validated scale available and, therefore, should be the first choice in a clinical setting.
Researchers evaluated literature from 1980 to January 2015 looking for assessments of bowel preparation scales. They included 14 studies that evaluated seven different scales and concluded that all scales had limitations; however, the Boston bowel preparation scale (BBPS) was the most thoroughly validated and was assessed in five of the 14 studies.
An association was found between increasing BBPS scores and greater polyp detection (left colon, OR = 2.58; 95% CI, 1.34-4.98; right colon, OR = 1.6; 95% CI, 1.01-2.55). Researchers also found fewer repeat colonoscopies were associated with increasing BBPS scores (cutoff of 5, P < .001), as were shorter insertion/withdrawal times (P < .001). Substantial-to-excellent interobserver and intraobserver reliability also was observed with the BBPS (intraclass correlation coefficient [ICC] = 0.74-0.91).
Other scales have been less validated, but studies have shown:
- The Aronchick scale had fair-to-substantial interobserver reliability (ICC = 0.31-0.76).
- The Ottawa bowel preparation quality scale exhibited superior interobserver reliability (ICC = 0.94).
- The Harefield cleansing scale showed fair-to-moderate interobserver (ICC = 0.46 [0.37-0.54]) and intraobserver reliabilities (kappa statistic = 0.28).
- The Chicago bowel preparation scale had excellent interobserver reliability (Pearson correlation = 0.84 [0.79-0.88]).
“Between-scale comparisons for repeat colonoscopy time interval, ease and pertinence of use for auditing are needed,” the researchers wrote. “Although there exists several validated bowel preparation scales, they satisfy a varying spectrum of optimal criteria for a high-quality measurement scale. The BBPS remains the most extensively validated and most user-friendly scale published to date and should be used in a clinical setting at this time.” – by Suzanne Reist
Disclosure: The researchers report no relevant financial disclosures.