KODA score: an updated and validated bowel preparation scale for patients undergoing small bowel capsule endoscopy

Mohammad Alageeli; Brian Yan; Suliman Alshankiti; May Al-Zahrani; Zoya Bahreini; ThucNhi T. Dang; Joshua Friedland; Syed Gilani; Ravi Homenauth; Jennifer Houle; Milica Kloc; Jacqueline Luhoway; Lucas Merotto; Rymon Rofaiel; Chantal Singh; Alexis Smith; Benson Thomas; Cassandra Townsend; David Yoo; Sergio Zepeda-Gomez; Larry Stitt; Vipul Jairath; Michael Sai Lai Sey

doi:10.1055/a-1176-9889

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(08): E1011-E1017
DOI: 10.1055/a-1176-9889

Original article

KODA score: an updated and validated bowel preparation scale for patients undergoing small bowel capsule endoscopy

Mohammad Alageeli

¹Division of Gastroenterology, Western University, London, Ontario, Canada

,

Brian Yan

¹Division of Gastroenterology, Western University, London, Ontario, Canada

,

Suliman Alshankiti

²Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada

,

May Al-Zahrani

¹Division of Gastroenterology, Western University, London, Ontario, Canada

,

Zoya Bahreini

¹Division of Gastroenterology, Western University, London, Ontario, Canada

,

ThucNhi T. Dang

,

Joshua Friedland

³Schulich School of Medicine, Western University, London, Ontario, Canada

,

Syed Gilani

³Schulich School of Medicine, Western University, London, Ontario, Canada

,

Ravi Homenauth

²Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada

,

Jennifer Houle

⁴London Health Sciences Centre, London, Ontario, Canada

,

Milica Kloc

⁴London Health Sciences Centre, London, Ontario, Canada

,

Jacqueline Luhoway

³Schulich School of Medicine, Western University, London, Ontario, Canada

,

Lucas Merotto

³Schulich School of Medicine, Western University, London, Ontario, Canada

,

Rymon Rofaiel

⁵Department of Medicine, London Health Sciences Center, London, Ontario, Canada

,

Chantal Singh

⁴London Health Sciences Centre, London, Ontario, Canada

,

Alexis Smith

⁶Arthur Labatt School of Nursing, Western University, London, Ontario, Canada

,

Benson Thomas

¹Division of Gastroenterology, Western University, London, Ontario, Canada

,

Cassandra Townsend

¹Division of Gastroenterology, Western University, London, Ontario, Canada

,

David Yoo

⁵Department of Medicine, London Health Sciences Center, London, Ontario, Canada

,

Sergio Zepeda-Gomez

²Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada

,

Larry Stitt

⁷Robarts Clinical Trials Inc., London, Ontario, Canada

,

Vipul Jairath

¹Division of Gastroenterology, Western University, London, Ontario, Canada

⁷Robarts Clinical Trials Inc., London, Ontario, Canada

⁸Program for Experimental Medicine, Western University, London, Ontario, Canada

⁹Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada

,

Michael Sai Lai Sey

¹Division of Gastroenterology, Western University, London, Ontario, Canada

⁸Program for Experimental Medicine, Western University, London, Ontario, Canada

› Author Affiliations

Abstract

Background and study aims A reliable outcome measure is needed for bowel preparation quality during capsule endoscopy. Currently, no scales are adequately validated. Our objective was to update an existing small bowel preparation score, create a standardized training module, then determine its inter-rater and intra-rater reliability.

Patients and methods Modification to produce standardized scoring of an existing small bowel preparation score was performed followed by development of a training module and validation to create the new Korea-Canada (KODA) score. Twenty readers from a range of backgrounds, including capsule endoscopists, gastroenterology fellows, residents, medical students, and nurses rated bowel cleanliness in 25 capsule videos consisting of 1,233 images, in duplicate 4 weeks apart, after completing the training module. Sequential images selected in 5-minute intervals during small bowel transit were rated on a scale between 0–3 based on the amount of visualized mucosa and the degree of obstruction. Reliability was assessed using estimates of intraclass correlation coefficients (ICCs).

Results Intraclass correlation coefficients for inter-rater (ICC 0.81, 95 % CI 0.70–0.87) and intra-rater (ICC 0.92, 95 % CI 0.87–0.94) reliability were almost perfect among the 20 readers. Inter-rater reliability ranged between 0.72 (95 % CI 0.57–0.81) and 0.89 (95 % CI 0.79–0.93) for nurses and residents, respectively. Intra-rater reliability was greater than 0.90 for all groups except for nurses, which was still almost perfect (ICC 0.86, 95 % CI 0.79–0.90).

Conclusions Almost perfect inter-rater and intra-rater reliability was observed for the KODA score. This simple score could be used for future clinical trials after completion of the training module.

Full Text

References

References
1 Iddan G, Meron G, Glukhovsky A. et al. Wireless capsule endoscopy. Nature 2000; 405: 417
2 Pennazio M, Spada C, Eliakim R. et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2015; 47: 352-376
3 Enns RA, Hookey L, Armstrong D. et al. Clinical Practice Guidelines for the Use of Video Capsule Endoscopy. Gastroenterology 2017; 152: 497-514
4 Parmar R, Martel M, Rostom A. et al. Validated scales for colon cleansing: a systematic review. Am J Gastroenterol 2016; 111: 197-204
5 Lapalus MG, Ben Soussan E, Saurin JC. et al. Capsule endoscopy and bowel preparation with oral sodium phosphate: a prospective randomized controlled trial. Gastrointest Endosc 2008; 67: 1091-1096
6 Wei W, Ge ZZ, Lu H. et al. Purgative bowel cleansing combined with simethicone improves capsule endoscopy imaging. Am J Gastroenterol 2008; 103: 77-82
7 Pons Beltran V, Gonzalez Suarez B, Gonzalez Asanza C. et al. Evaluation of different bowel preparations for small bowel capsule endoscopy: a prospective, randomized, controlled study. Dig Dis Sci 2011; 56: 2900-2905
8 Chen HB, Lian-Xiang P, Yue H. et al. Randomized controlled trial of 3 days fasting and oral senna, combined with mannitol and simethicone, before capsule endoscopy. Medicine 2017; 96: e8322
9 Paul C, Price RSJ, Chiang IA. Research Methods in Psychology. 2nd Canadian Edition. The Saylor Foundation; 2015: 90-94
10 Kotwal VS, Attar BM, Gupta S. et al. Should bowel preparation, antifoaming agents, or prokinetics be used before video capsule endoscopy? A systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2014; 26: 137-145
11 Gkolfakis P, Tziatzios G, Dimitriadis GD. et al. Meta-analysis of randomized controlled trials challenging the usefulness of purgative preparation before small-bowel video capsule endoscopy. Endoscopy 2018; 50: 671-683
12 Viazis N, Sgouros S, Papaxoinis K. et al. Bowel preparation increases the diagnostic yield of capsule endoscopy: a prospective, randomized, controlled study. Gastrointest Endosc 2004; 60: 534-538
13 Wi JH, Moon JS, Choi MG. et al. Bowel preparation for capsule endoscopy: a prospective randomized multicenter study. Gut Liver 2009; 3: 180-185
14 Rosa BJ, Barbosa M, Magalhaes J. et al. Oral purgative and simethicone before small bowel capsule endoscopy. World J Gastrointest Endosc 2013 5: 67-73
15 Hookey L, Louw J, Wiepjes M. et al. Lack of benefit of active preparation compared with a clear fluid-only diet in small-bowel visualization for video capsule endoscopy: results of a randomized, blinded, controlled trial. Gastrointest Endosc 2017; 85: 187-193
16 van Tuyl SA, den Ouden H, Stolk MF. et al. Optimal preparation for video capsule endoscopy: a prospective, randomized, single-blind study. Endoscopy 2007; 39: 1037-1040
17 Franke A, Hummel F, Knebel P. et al. Prospective evaluation of small bowel preparation with bisacodyl and sodium phosphate for capsule endoscopy. World J Gastrointest Endosc 2008; 14: 2061-2064
18 Postgate A, Tekkis P, Patterson N. et al. Are bowel purgatives and prokinetics useful for small-bowel capsule endoscopy? A prospective randomized controlled study. Gastrointest Endosc 2009; 69: 1120-1128
19 Park SC, Keum B, Hyun JJ. et al. A novel cleansing score system for capsule endoscopy. World J Gastrointest Endosc 2010; 16: 875-880
20 Eliasziw M, Young SL, Woodbury MG. et al. Statistical methodology for the concurrent assessment of interrater and intra-rater reliability: using goniometric measurements as an example. Phys Ther 1994; 74: 777-788
21 Davison ACHD. Bootstrap methods and their application. Cambridge: University Press; 1997
22 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159
23 Samaan MA, Shen B, Mosli MH. et al. Reliability among central readers in the evaluation of endoscopic disease activity in pouchitis. Gastrointest Endosc 2018; 88: 360-369.e2
24 Hong-Bin C, Yue H, Su-Yu C. et al. Evaluation of visualized area percentage assessment of cleansing score and computed assessment of cleansing score for capsule endoscopy. Saudi J Gastroenterol 2013; 19: 160-164
25 Chan RHL, Louw J. et al. Reliability study to assess a measure of small bowel cleanliness in video capsule endoscopy. Can J Gastroenterol Hepatol 2008; 22: A341
26 Fireman Z, Paz D, Kopelman Y. Capsule endoscopy: improving transit time and image view. World J Gastrointest Endosc 2005; 11: 5863-5866
27 Dai N, Gubler C, Hengstler P. Improved capsule endoscopy after bowel preparation. Gastrointest Endosc 2005; 61: 28-31
28 Adler SN, Farkash S, Sompolinsky Y. et al. A novel purgative protocol for capsule endoscopy of the small bowel produces better quality of visibility than 2 l of PEG: Timing is of the essence. United European Gastroenterol J 2017; 5: 485-490
29 Brotz C, Nandi N, Conn M. et al. A validation study of 3 grading systems to evaluate small-bowel cleansing for wireless capsule endoscopy: a quantitative index, a qualitative evaluation, and an overall adequacy assessment. Gastrointest Endosc 2009; 69: 262-270
30 Esaki M, Matsumoto T, Kudo T. et al. Bowel preparations for capsule endoscopy: a comparison between simethicone and magnesium citrate. Gastrointest Endosc 2009; 69: 94-101
31 Ito T, Ohata K, Ono A. et al. Prospective controlled study on the effects of polyethylene glycol in capsule endoscopy. World J Gastrointest Endosc 2012; 18: 1789-1792
32 Oliva S, Cucchiara S, Spada C. et al. Small bowel cleansing for capsule endoscopy in paediatric patients: a prospective randomized single-blind study. Dig Liver Dis 2014; 46: 51-55
33 Van Weyenberg SJ, De Leest HT, Mulder CJ. Description of a novel grading system to assess the quality of bowel preparation in video capsule endoscopy. Endoscopy 2011; 43: 406-411
34 Chen HB, Huang Y, Chen SY. et al. Small bowel preparations for capsule endoscopy with mannitol and simethicone: a prospective, randomized, clinical trial. J Clin Gastroenterol 2011; 45: 337-341