Taveira Filipe, Hassan Cesare, Kaminski Michal F, Ponchon Thierry, Benamouzig Robert, Bugajski Marek, de Castelbajac Flore, Cesaro Paola, Chergui Hasnae, Goran Loredana, Minelli Grazioli Leonardo, Janičko Martin, Januszewicz Wladyslaw, Lamonaca Laura, Lenz Jamila, Negreanu Lucian, Repici Alessandro, Spada Cristiano, Spadaccini Marco, State Monica, Szlak Jakub, Veseliny Eduard, Dinis-Ribeiro Mário, Areia Miguel
Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal.
Gastroenterology and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy.
Endoscopy. 2022 Jan;54(1):45-51. doi: 10.1055/a-1331-4325. Epub 2021 Feb 12.
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).
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).
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.
CEBuS proved to be a reliable instrument to standardize the evaluation of colonic bubbles during colonoscopy. Assessment in daily practice is warranted.
迄今为止，尚无用于评估肠道准备相关气泡的量表得到验证。本研究旨在开发并评估一种新型量表——结肠内镜气泡量表（CEBuS）的可靠性。
这是一项多中心、前瞻性观察性研究，有两个在线评估阶段，每个阶段随机分布45张结肠oscopy图像（每个量表等级15张）。观察者使用CEBuS（CEBuS-0——无气泡或气泡极少，覆盖面积<5%；CEBuS-1——气泡覆盖面积为5%-50%；CEBuS-2——气泡覆盖面积>50%）对图像进行两次评估，间隔2周，并报告临床处理措施（不做处理；用水冲洗；用西甲硅油冲洗）。
CEBuS在评估阶段1（4名专家）和阶段2（6名专家和13名非专家）中均显示出高度一致性，观察者内信度几乎完美：kappa值分别为0.82（95%置信区间0.75-0.88）和0.86（0.85-0.88）；观察者间一致性——组内相关系数（ICC）分别为0.83（0.73-0.89）和0.90（0.86-0.94）。既往内镜经验对专家和非专家之间的一致性没有影响：kappa值分别为0.86（0.80-0.91）和0.87（0.84-0.89），ICC分别为0.91（0.87-0.94）和0.90（0.86-0.94）。阶段1观察者间在临床处理措施上的一致性ICC为0.63（0.43-0.78），阶段2为0.77（0.68-0.84）。每个量表等级在临床处理措施上的绝对一致性，CEBuS-0为85%（82-88），CEBuS-1为21%（16-26），CEBuS-2为74%（70-78）。
CEBuS被证明是一种可靠的工具，可用于标准化结肠镜检查期间结肠气泡的评估。有必要在日常实践中进行评估。
