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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
1   Division of Gastroenterology, Western University, London, Ontario, Canada
,
Brian Yan
1   Division of Gastroenterology, Western University, London, Ontario, Canada
,
Suliman Alshankiti
2   Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
,
May Al-Zahrani
1   Division of Gastroenterology, Western University, London, Ontario, Canada
,
Zoya Bahreini
1   Division of Gastroenterology, Western University, London, Ontario, Canada
,
ThucNhi T. Dang
,
Joshua Friedland
3   Schulich School of Medicine, Western University, London, Ontario, Canada
,
Syed Gilani
3   Schulich School of Medicine, Western University, London, Ontario, Canada
,
Ravi Homenauth
2   Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
,
Jennifer Houle
4   London Health Sciences Centre, London, Ontario, Canada
,
Milica Kloc
4   London Health Sciences Centre, London, Ontario, Canada
,
Jacqueline Luhoway
3   Schulich School of Medicine, Western University, London, Ontario, Canada
,
Lucas Merotto
3   Schulich School of Medicine, Western University, London, Ontario, Canada
,
Rymon Rofaiel
5   Department of Medicine, London Health Sciences Center, London, Ontario, Canada
,
Chantal Singh
4   London Health Sciences Centre, London, Ontario, Canada
,
Alexis Smith
6   Arthur Labatt School of Nursing, Western University, London, Ontario, Canada
,
Benson Thomas
1   Division of Gastroenterology, Western University, London, Ontario, Canada
,
Cassandra Townsend
1   Division of Gastroenterology, Western University, London, Ontario, Canada
,
David Yoo
5   Department of Medicine, London Health Sciences Center, London, Ontario, Canada
,
Sergio Zepeda-Gomez
2   Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
,
Larry Stitt
7   Robarts Clinical Trials Inc., London, Ontario, Canada
,
Vipul Jairath
1   Division of Gastroenterology, Western University, London, Ontario, Canada
7   Robarts Clinical Trials Inc., London, Ontario, Canada
8   Program for Experimental Medicine, Western University, London, Ontario, Canada
9   Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
,
Michael Sai Lai Sey
1   Division of Gastroenterology, Western University, London, Ontario, Canada
8   Program for Experimental Medicine, Western University, London, Ontario, Canada
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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.



Publication History

Received: 13 November 2019

Accepted: 01 April 2020

Article published online:
21 July 2020

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