Small Bowel CLEansing Assessment and Report (SB-CLEAR): Standardizing bowel preparation report in capsule endoscopy

Background and aimSmall-bowel (SB) cleansing is crucial to assess the reliability of capsule endoscopy (CE) findings. However, the presence of multiple grading systems is hampering their use in clinical practice. In 2020, Colon CLeansing Assessment and Report (CC-CLEAR) was created and validated. We sought to develop and validate a new score for the evaluation of the SB cleansing, adapted from CC-CLEAR, aiming to standardize CE reporting regarding the quality of preparation. MethodsThe new grading score, SB CLeansing Assessment and Report (SB-CLEAR), divided the SB into three tertiles, each being scored depending on the percentage of visualized mucosa (0, < 50%; 1, 50%-75%; 2, > 75%; 3, > 90%). The overall classification was a sum of each segment score, graded between excellent, good, and inadequate (0-5). Any segment scoring <= 1 resulted in inadequate overall classification. CE videos were prospectively evaluated by two experienced CE readers blinded to each other. ResultsWe included 52 CEs, 41(78.8%) female, with a mean age of 57.9 +/- 17.9 years. Inter-observer agreement was very strong for each tertile (first: r = 0.863; second: r = 0.865; third: r = 0.861; P < 0.001), which resulted in overall excellent correlation when considering the quality of preparation in all tertiles (r = 0.940; P < 0.001). By applying final classifications of inadequate, good, and excellent, correlation between observers was also very strong (r = 0.875; P < 0.001). ConclusionsSB-CLEAR is an innovative and reproducible grading score for evaluation of SB preparation quality in CE, with overall excellent inter-observer agreement. Along with CC-CLEAR, this may become a valuable tool to uniformize reporting of bowel preparation quality in CE.

Automated summary

SB-CLEAR is a novel and reproducible grading score for evaluating the quality of small bowel preparation in capsule endoscopy (CE). It has demonstrated excellent inter-observer agreement and may serve as a valuable tool, along with CC-CLEAR, for standardizing the reporting of bowel preparation quality in CE.