Boston Bowel Preparation Scale scores provide a standardized definition of adequate for describing bowel cleanliness

Background: Establishing a threshold of bowel cleanliness below which colonoscopies should be repeated at accelerated intervals is important, yet there are no standardized definitions for an adequate preparation. Objective: To determine whether Boston Bowel Preparation Scale (BBPS) scores could serve as a standard definition of adequacy. Design: Cross-sectional observational analysis of colonoscopy data from 36 adult GI endoscopy practices and prospective survey showing 4 standardized colonoscopy videos with varying degrees of bowel cleanliness. Setting: The Clinical Outcomes Research Initiative. Patients: Average-risk patients attending screening colonoscopy. Interventions: Colonoscopy. Main Outcome Measurements: Recommended follow-up intervals among average-risk, screening colonoscopies without polyps stratified by BBPS scores. Results: We evaluated 2516 negative screening colonoscopies performed by 74 endoscopists. If the BBPS score was >= 2 in all 3 segments (N = 2295), follow-up was recommended in 10 years in 90% of cases. Examinations with total BBPS scores of 3 to 5 (N = 167) had variable recommendations. Follow-up within 1 year was recommended for 96% of examinations with total BBPS scores of 0 to 2 (N = 26). Similar results were noted among 167 participants in a video survey with pre-established BBPS scores. Limitations: Retrospective study. Conclusion: BBPS scores correlate with endoscopist behavior regarding follow-up intervals for colonoscopy. A total BBPS score >= 6 and/or all segment scores >= 2 provides a standardized definition of adequate for 10-year follow-up, whereas total scores <= 2 indicate that a procedure should be repeated within 1 year. Future work should focus on finding consensus for management of examinations with total scores of 3 to 5.