Development of a computed cleansing score to assess quality of bowel preparation in colon capsule endoscopy

Background and study aims Colon capsule endoscopy (CCE) does not possess an objective and reliable scoring system to assess the quality of visualization of the colon mucosa. The aim of this study was to establish a colonic computed assessment of cleansing (CAC) score able to discriminate adequately cleansed from inadequately cleansed CCE still frames. Patients and methods Twelve normal and complete CCEs, using the Pillcam Colon 2 system (Medtronic, Minnesota, United States), were prospectively selected amongst a database. A CAC score, defined as the ratio of color intensities red over green (R/G ratio), and red over brown (R/(R+G) ratio) was calculated for each extracted colonic frame. After sorting and random selection, two sets of still frames representative of the range of these ratios were obtained. These images were analyzed twice in random order by two experienced CCE readers who were blinded to the CAC scores. A receiver operating characteristic (ROC) curve was forged for both types of ratios and a threshold established, yielding the highest diagnostic performance in terms of adequate cleansing assessment. Results Four-hundred-and-eight frames were extracted. Regarding the R/G ratio, a threshold value of 1.55 was calculated, with a sensitivity of 86.5% and a specificity of 77.7%. Regarding the R/(R+G) ratio, a threshold value of 0.58 was calculated with a sensitivity of 95.5% and a specificity of 62.9%. Conclusion The two proposed CAC scores based on the ratio of color intensities come with high sensitivities for discriminating between adequately cleansed and inadequately cleansed CCE still frames, but they lack specificity. Further refinement, with implementation of additional image parameters, is warranted.