Post written by Rui de Sousa Magalhães, MD, from the Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, and ICVS/3B’s, PT Government Associate Laboratory, Guimarães/Braga, Portugal.
Our focus was the creation of a new grading scale for the evaluation of colon capsule cleansing, the CC-CLEAR (Colon Capsule CLEansing Assessment and Report).
As a tertiary center with expertise in capsule endoscopy we deal daily with a large number of procedures and reporting issues. The inconsistency in the reportable grades of the quality of bowel cleansing in colon capsule (CC) between experienced coworkers prompted the need to optimize reproducibility and objectivity. Colon capsule findings are as reliable as the trustworthiness of the evaluation of the quality of bowel preparation, and the currently available CC cleansing scales rely on subjective guidelines and display a lack of reproducibility. It is important to mention that conventional colonoscopy cleansing scales are not suitable to assess the colon capsule quality of bowel cleansing, primarily because they were not tested on this specific setting, and secondly, “real-time” optimization based on actions such as “washing” and “sucking” are not possible in colon capsule.
A capsule colonoscopy under suboptimal cleansing conditions may be associated with great inconvenience both to patients and healthcare providers. Thus, quality assessment criteria to assure proper bowel cleansing classification is of paramount importance and should be standardized, avoiding vague and ambiguous qualitative terms such as “adequate,” “good,” “fair,” and “poor” that have been reported unevenly among physicians. Acknowledging the need for a higher intra- and interobserver agreement when evaluating the quality of colon capsule cleansing, we aimed to create a new quantitative grading scale, CC-CLEAR.
Our study provides physicians with an innovative, practical, and user-friendly bowel preparation scale to evaluate the quality of bowel cleansing in colon capsule, the CC-CLEAR. Besides being easy to apply, it performs exceptionally, with excellent intra- and interobserver agreement rates, relying on objective parameters and quantitative measures, which make it readily available for use in clinical practice.
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