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1. The Colon Endoscopic Bubble Scale (CEBuS): A two-phase evaluation study

Author

Taveira, F., Hassan, Cesare, Kaminski, M. F., Ponchon, T., Benamouzig, R., Bugajski, M., De Castelbajac, F., Cesaro, Paola, Chergui, H., Goran, L., Minelli Grazioli, L., Janicko, M., Januszewicz, W., Lamonaca, L., Lenz, J., Negreanu, L., Repici, A., Spada, Cristiano, Spadaccini, M., State, M., Szlak, J., Veseliny, E., Dinis-Ribeiro, M., Areia, M., Hassan C., Cesaro P., Spada C. (ORCID:0000-0002-5692-0960), Taveira, F., Hassan, Cesare, Kaminski, M. F., Ponchon, T., Benamouzig, R., Bugajski, M., De Castelbajac, F., Cesaro, Paola, Chergui, H., Goran, L., Minelli Grazioli, L., Janicko, M., Januszewicz, W., Lamonaca, L., Lenz, J., Negreanu, L., Repici, A., Spada, Cristiano, Spadaccini, M., State, M., Szlak, J., Veseliny, E., Dinis-Ribeiro, M., Areia, M., Hassan C., Cesaro P., and Spada C. (ORCID:0000-0002-5692-0960)

Abstract

Background To date, no scale has been validated to assess bubbles associated with bowel preparation. This study aimed to develop and assess the reliability of a novel scale - the Colon Endoscopic Bubble Scale (CEBuS). Methods This was a multicenter, prospective, observational study with two online evaluation phases of 45 randomly distributed still colonoscopy images (15 per scale grade). Observers assessed images twice, 2 weeks apart, using CEBuS (CEBuS-0 - no or minimal bubbles, covering<5% of the surface; CEBuS-1 - bubbles covering 5%-50%; CEBuS-2 - bubbles covering >50%) and reporting the clinical action (do nothing; wash with water; wash with simethicone). Results CEBuS provided high levels of agreement both in evaluation Phase 1 (4 experts) and Phase 2 (6 experts and 13 non-experts), with almost perfect intraobserver reliability: kappa 0.82 (95% confidence interval 0.75-0.88) and 0.86 (0.85-0.88); interobserver agreement - intraclass correlation coefficient (ICC) 0.83 (0.73-0.89) and 0.90 (0.86-0.94). Previous endoscopic experience had no influence on agreement among experts vs. non-experts: kappa 0.86 (0.80-0.91) vs. 0.87 (0.84-0.89) and ICC 0.91 (0.87-0.94) vs. 0.90 (0.86-0.94), respectively. Interobserver agreement on clinical action was ICC 0.63 (0.43-0.78) in Phase 1 and 0.77 (0.68-0.84) in Phase 2.Absolute agreement on clinical action per scale grade was 85% (82-88) for CEBuS-0, 21% (16-26) for CEBuS-1, and 74% (70-78) for CEBuS-2. Conclusion CEBuS proved to be a reliable instrument to standardize the evaluation of colonic bubbles during colonoscopy. Assessment in daily practice is warranted.

Published
2022

2. Comparison of Quality Measures for Detection of Neoplasia at Screening Colonoscopy.

Author

Wieszczy P, Bugajski M, Januszewicz W, Rupinska M, Szlak J, Pisera M, Turkot MH, Rupinski M, Wojciechowska U, Didkowska J, Regula J, and Kaminski MF

Subjects
Humans, Male, Middle Aged, Female, Quality Indicators, Health Care, Colonoscopy, Risk, Mass Screening, Early Detection of Cancer, Colorectal Neoplasms diagnosis, Colorectal Neoplasms epidemiology, Adenoma diagnosis
Abstract

Background & Aims: The proportion of colonoscopies with at least one adenoma (adenoma detection rate [ADR]) is inversely associated with colorectal cancer (CRC) risk and death. The aim of this study was to examine whether such associations exist for colonoscopy quality measures other than ADR., Methods: We used data from the Polish Colorectal Cancer Screening Program collected in 2000-2011. For all endoscopists who performed ≥100 colonoscopies we calculated detection rates of adenomas (ADR), polyps (PDR), and advanced adenomas (≥10 mm/villous component/high-grade dysplasia [AADR]); and number of adenomas per colonoscopy (APC) and per colonoscopy with ≥1 adenoma (APPC). We followed patients until CRC diagnosed before recommended surveillance, death, or December 31, 2019. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional-hazard models. We used Harrell's C statistic to compare the predictive power of the quality measures., Results: Data on 173,287 patients (median age, 56 years; 37.8% male) and 262 endoscopists were used. During a median follow-up of 10 years and 1,490,683 person-years, we identified 395 CRCs. All quality measures were significantly associated with CRC risk and death. The relative reductions in CRC risk were as follows: for ADR ≥24.9% (reference <12.1%; HR, 0.41; 95% CI, 0.25-0.66), PDR ≥42.7% (reference <19.9%; HR, 0.35; 95% CI, 0.24-0.51), AADR ≥9.1% (reference <4.1%; HR, 0.69; 95% CI, 0.49-0.96), APC ≥0.37 (reference <0.15; HR, 0.35; 95% CI, 0.21-0.58), and APPC ≥1.54 (reference <1.19; HR, 0.54; 95% CI, 0.35-0.83). AADR was the only quality measure with significantly lower predictive power than ADR (Harrell's C, 59.7 vs 63.4; P = .001). Similar relative reductions were observed for CRC death., Conclusions: This large observational study confirmed the inverse association between ADR and CRC risk and death. The PDR and APC quality measures appear to be comparable with ADR., (Copyright © 2023 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Published
2023
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