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Bowel cleansing quality evaluation in colon capsule endoscopy : what is the reference standard?

Schelde-Olesen, Benedicte ; Koulaouzidis, Anastasios LU ; Deding, Ulrik ; Toth, Ervin LU ; Dabos, Konstantinos John ; Eliakim, Abraham ; Carretero, Cristina ; González-Suárez, Begoña ; Dray, Xavier and de Lange, Thomas , et al. (2024) In Therapeutic Advances in Gastroenterology 17.
Abstract

Background: The diagnostic accuracy of colon capsule endoscopy (CCE) depends on a well-cleansed bowel. Evaluating the cleansing quality can be difficult with a substantial interobserver variation. Objectives: Our primary aim was to establish a standard of agreement for bowel cleansing in CCE based on evaluations by expert readers. Then, we aimed to investigate the interobserver agreement on bowel cleansing. Design: We conducted an interobserver agreement study on bowel cleansing quality. Methods: Readers with different experience levels in CCE and colonoscopy evaluated bowel cleansing quality on the Leighton–Rex scale and Colon Capsule CLEansing Assessment and Report (CC-CLEAR), respectively. All evaluations were reported on an image... (More)

Background: The diagnostic accuracy of colon capsule endoscopy (CCE) depends on a well-cleansed bowel. Evaluating the cleansing quality can be difficult with a substantial interobserver variation. Objectives: Our primary aim was to establish a standard of agreement for bowel cleansing in CCE based on evaluations by expert readers. Then, we aimed to investigate the interobserver agreement on bowel cleansing. Design: We conducted an interobserver agreement study on bowel cleansing quality. Methods: Readers with different experience levels in CCE and colonoscopy evaluated bowel cleansing quality on the Leighton–Rex scale and Colon Capsule CLEansing Assessment and Report (CC-CLEAR), respectively. All evaluations were reported on an image level. A total of 24 readers rated 500 images on each scale. Results: An expert opinion-based agreement standard could be set for poor and excellent cleansing but not for the spectrum in between, as the experts agreed on only a limited number of images representing fair and good cleansing. The overall interobserver agreement on the Leighton–Rex full scale was good (intraclass correlation coefficient (ICC) 0.84, 95% CI (0.82–0.85)) and remained good when stratified by experience level. On the full CC-CLEAR scale, the overall agreement was moderate (ICC 0.62, 95% CI (0.59–0.65)) and remained so when stratified by experience level. Conclusion: The interobserver agreement was good for the Leighton–Rex scale and moderate for CC-CLEAR, irrespective of the reader’s experience level. It was not possible to establish an expert-opinion standard of agreement for cleansing quality in CCE images. Dedicated training in using the scales may improve agreement and enable future algorithm calibration for artificial intelligence supported cleansing evaluation. Trial registration: All included images were derived from the CAREforCOLON 2015 trial (Registered with The Regional Health Research Ethics Committee (Registration number: S-20190100), the Danish data protection agency (Ref. 19/29858), and ClinicalTrials.gov (registration number: NCT04049357)).

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
artificial intelligence algorithm, bowel cleansing, colon capsule endoscopy, interobserver agreement
in
Therapeutic Advances in Gastroenterology
volume
17
publisher
SAGE Publications
external identifiers
  • scopus:85207210123
  • pmid:39449979
ISSN
1756-283X
DOI
10.1177/17562848241290256
language
English
LU publication?
yes
additional info
Publisher Copyright: © The Author(s), 2024.
id
e72c2427-3b67-43bc-b97a-01506e4a5135
date added to LUP
2024-12-17 08:43:44
date last changed
2025-07-16 01:29:37
@article{e72c2427-3b67-43bc-b97a-01506e4a5135,
  abstract     = {{<p>Background: The diagnostic accuracy of colon capsule endoscopy (CCE) depends on a well-cleansed bowel. Evaluating the cleansing quality can be difficult with a substantial interobserver variation. Objectives: Our primary aim was to establish a standard of agreement for bowel cleansing in CCE based on evaluations by expert readers. Then, we aimed to investigate the interobserver agreement on bowel cleansing. Design: We conducted an interobserver agreement study on bowel cleansing quality. Methods: Readers with different experience levels in CCE and colonoscopy evaluated bowel cleansing quality on the Leighton–Rex scale and Colon Capsule CLEansing Assessment and Report (CC-CLEAR), respectively. All evaluations were reported on an image level. A total of 24 readers rated 500 images on each scale. Results: An expert opinion-based agreement standard could be set for poor and excellent cleansing but not for the spectrum in between, as the experts agreed on only a limited number of images representing fair and good cleansing. The overall interobserver agreement on the Leighton–Rex full scale was good (intraclass correlation coefficient (ICC) 0.84, 95% CI (0.82–0.85)) and remained good when stratified by experience level. On the full CC-CLEAR scale, the overall agreement was moderate (ICC 0.62, 95% CI (0.59–0.65)) and remained so when stratified by experience level. Conclusion: The interobserver agreement was good for the Leighton–Rex scale and moderate for CC-CLEAR, irrespective of the reader’s experience level. It was not possible to establish an expert-opinion standard of agreement for cleansing quality in CCE images. Dedicated training in using the scales may improve agreement and enable future algorithm calibration for artificial intelligence supported cleansing evaluation. Trial registration: All included images were derived from the CAREforCOLON 2015 trial (Registered with The Regional Health Research Ethics Committee (Registration number: S-20190100), the Danish data protection agency (Ref. 19/29858), and ClinicalTrials.gov (registration number: NCT04049357)).</p>}},
  author       = {{Schelde-Olesen, Benedicte and Koulaouzidis, Anastasios and Deding, Ulrik and Toth, Ervin and Dabos, Konstantinos John and Eliakim, Abraham and Carretero, Cristina and González-Suárez, Begoña and Dray, Xavier and de Lange, Thomas and Beaumont, Hanneke and Rondonotti, Emanuele and Kopylov, Uri and Ellul, Pierre and Pérez-Cuadrado-Robles, Enrique and Robertson, Alexander and Stenfors, Irene and Bojorquez, Alejandro and Piccirelli, Stefania and Raabe, Gitte Grunnet and Margalit-Yehuda, Reuma and Barba, Isabel and Scardino, Giulia and Ouazana, Salome and Bjørsum-Meyer, Thomas}},
  issn         = {{1756-283X}},
  keywords     = {{artificial intelligence algorithm; bowel cleansing; colon capsule endoscopy; interobserver agreement}},
  language     = {{eng}},
  month        = {{01}},
  publisher    = {{SAGE Publications}},
  series       = {{Therapeutic Advances in Gastroenterology}},
  title        = {{Bowel cleansing quality evaluation in colon capsule endoscopy : what is the reference standard?}},
  url          = {{http://dx.doi.org/10.1177/17562848241290256}},
  doi          = {{10.1177/17562848241290256}},
  volume       = {{17}},
  year         = {{2024}},
}