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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 
 1   Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
,
Cesare Hassan
 2   Gastroenterology and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
,
Michal F. Kaminski
 3   Department of Gastroenterological Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
 4   Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
 5   Department of Cancer Prevention, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
 6   Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
,
Thierry Ponchon
 7   Department of Hepatogastroenterology, Hôpital Edouard Herriot, Lyon, France
,
Robert Benamouzig
 8   Service de Gastroentérologie, Hôpital Avicenne (APHP), Bobigny, France
,
Marek Bugajski
 3   Department of Gastroenterological Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
 4   Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
,
Flore de Castelbajac
 8   Service de Gastroentérologie, Hôpital Avicenne (APHP), Bobigny, France
,
Paola Cesaro
 9   Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
,
Hasnae Chergui
 8   Service de Gastroentérologie, Hôpital Avicenne (APHP), Bobigny, France
,
Loredana Goran
10   Department of Gastroenterology, University Hospital, ‘Carol Davila’ University Bucharest, Romania
,
Leonardo Minelli Grazioli
 9   Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
,
Martin Janičko
11   2nd Department of Internal Medicine, Pavol Jozef Šafárik University, Košice, Slovakia
,
Wladyslaw Januszewicz
 3   Department of Gastroenterological Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
 4   Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
,
Laura Lamonaca
12   Endoscopy Unit, Humanitas Clinical and Research Center – IRCCS –, Rozzano, Lombardia, Italy
,
Jamila Lenz
 7   Department of Hepatogastroenterology, Hôpital Edouard Herriot, Lyon, France
,
Lucian Negreanu
10   Department of Gastroenterology, University Hospital, ‘Carol Davila’ University Bucharest, Romania
,
Alessandro Repici
12   Endoscopy Unit, Humanitas Clinical and Research Center – IRCCS –, Rozzano, Lombardia, Italy
,
Cristiano Spada
 9   Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
13   Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy
,
Marco Spadaccini
12   Endoscopy Unit, Humanitas Clinical and Research Center – IRCCS –, Rozzano, Lombardia, Italy
,
Monica State
10   Department of Gastroenterology, University Hospital, ‘Carol Davila’ University Bucharest, Romania
,
Jakub Szlak
 3   Department of Gastroenterological Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
,
Eduard Veseliny
11   2nd Department of Internal Medicine, Pavol Jozef Šafárik University, Košice, Slovakia
,
Mário Dinis-Ribeiro
14   Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
15   Gastroenterology Department, Portuguese Oncology Institute of Porto, Portugal
,
Miguel Areia 
 1   Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
14   Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
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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.



Publication History

Received: 22 May 2020

Accepted after revision: 07 December 2020

Accepted Manuscript online:
07 December 2020

Article published online:
12 February 2021

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