The Colon Endoscopic Bubble Scale (CEBuS): a two-phase evaluation study

Filipe Taveira; Cesare Hassan; Michal F. Kaminski; Thierry Ponchon; Robert Benamouzig; Marek Bugajski; Flore de Castelbajac; Paola Cesaro; Hasnae Chergui; Loredana Goran; Leonardo Minelli Grazioli; Martin Janičko; Wladyslaw Januszewicz; Laura Lamonaca; Jamila Lenz; Lucian Negreanu; Alessandro Repici; Cristiano Spada; Marco Spadaccini; Monica State; Jakub Szlak; Eduard Veseliny; Mário Dinis-Ribeiro; Miguel Areia

doi:10.1055/a-1331-4325

Endoscopy, Table of Contents

Endoscopy 2022; 54(01): 45-51
DOI: 10.1055/a-1331-4325

Original article

The Colon Endoscopic Bubble Scale (CEBuS): a two-phase evaluation study

Filipe Taveira

¹Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal

,

Cesare Hassan

²Gastroenterology and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy

,

Michal F. Kaminski

³Department of Gastroenterological Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland

⁴Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Warsaw, Poland

⁵Department of Cancer Prevention, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland

⁶Department of Health Management and Health Economics, University of Oslo, Oslo, Norway

,

Thierry Ponchon

⁷Department of Hepatogastroenterology, Hôpital Edouard Herriot, Lyon, France

,

Robert Benamouzig

⁸Service de Gastroentérologie, Hôpital Avicenne (APHP), Bobigny, France

,

Marek Bugajski

³Department of Gastroenterological Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland

⁴Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Warsaw, Poland

,

Flore de Castelbajac

⁸Service de Gastroentérologie, Hôpital Avicenne (APHP), Bobigny, France

,

Paola Cesaro

⁹Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy

,

Hasnae Chergui

⁸Service de Gastroentérologie, Hôpital Avicenne (APHP), Bobigny, France

,

Loredana Goran

¹⁰Department of Gastroenterology, University Hospital, ‘Carol Davila’ University Bucharest, Romania

,

Leonardo Minelli Grazioli

⁹Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy

,

Martin Janičko

¹¹2nd Department of Internal Medicine, Pavol Jozef Šafárik University, Košice, Slovakia

,

Wladyslaw Januszewicz

³Department of Gastroenterological Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland

⁴Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Warsaw, Poland

,

Laura Lamonaca

¹²Endoscopy Unit, Humanitas Clinical and Research Center – IRCCS –, Rozzano, Lombardia, Italy

,

Jamila Lenz

⁷Department of Hepatogastroenterology, Hôpital Edouard Herriot, Lyon, France

,

Lucian Negreanu

¹⁰Department of Gastroenterology, University Hospital, ‘Carol Davila’ University Bucharest, Romania

,

Alessandro Repici

¹²Endoscopy Unit, Humanitas Clinical and Research Center – IRCCS –, Rozzano, Lombardia, Italy

,

Cristiano Spada

⁹Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy

¹³Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy

,

Marco Spadaccini

¹²Endoscopy Unit, Humanitas Clinical and Research Center – IRCCS –, Rozzano, Lombardia, Italy

,

Monica State

¹⁰Department of Gastroenterology, University Hospital, ‘Carol Davila’ University Bucharest, Romania

,

Jakub Szlak

³Department of Gastroenterological Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland

,

Eduard Veseliny

¹¹2nd Department of Internal Medicine, Pavol Jozef Šafárik University, Košice, Slovakia

,

Mário Dinis-Ribeiro

¹⁴Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal

¹⁵Gastroenterology Department, Portuguese Oncology Institute of Porto, Portugal

,

Miguel Areia

¹Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal

¹⁴Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal

› Author Affiliations

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.

Full Text

References

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