A validation study of 3 grading systems to evaluate small-bowel cleansing for wireless capsule endoscopy: a quantitative index, a qualitative evaluation, and an overall adequacy assessment
A validation study of 3 grading systems to evaluate small-bowel cleansing for wireless capsule endoscopy: a quantitative index, a qualitative evaluation, and an overall adequacy assessment
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DOI：
10.1016/j.gie.2008.04.016
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发表时间：
2009-02-01
影响因子：
7.7
通讯作者：
Kastenberg, David
中科院分区：
文献类型：
--
作者：
Brotz, Corey;Nandi, Neilanjan;Kastenberg, David
背景：胶囊内窥镜(CE)是评估小肠的有力工具。目的：通过前瞻性、随机性、单中心研究。研究地点：三级大学医院。干预：5名有经验的胶囊内窥镜医师两次阅读40CES，间隔1个月，在3个量表上对小肠清洁进行分级--定量指标(QI；0-10)、定性评价(QE；差、可、良)和总体充分性评价(OAA；不足、足够)。QI和QE评估了整个小肠和远端小肠。研究人员没有接受过这些量表的培训。主要结果测量：评估观察者内相关系数(重测)和观察者间可靠性。患者：40名在2005年6月至2006年5月接受ICE且符合入选标准的患者。结果：观察者内信度QI(0.60-0.66)中等，OAA(0.56)中等，QE(0.37-0.47)中等。观察者间得分较低，QI和OAA中等(分别为0.47-0-52和0.41)，QE为轻微至中等(0.20-0.24)。每个读者的整个小肠和远端小肠的QI评分高度相关(0.57-0.87)，远端小肠的评分低1.3分，表明清洁较差(P=.001)。优秀/良好与一般/差的QE具有中等到相当的观察者内和观察者间的可靠性(分别为0.58-0.66，0.41-0.49)。所有3个量表之间都有很强且高度显著的相关性(P<；.001，QI与QE和OAA)。结论：我们描述并验证了3个用于CE的小肠清洁分级的量表。对小肠清洁的评估应常规纳入CE报告。(胃肠内膜2009；69：262-70。)
Background: Capsule endoscopy (CE) is a powerful tool for evaluating the small bowel. Assessment of small-bowel cleansing for CE is an essential quality measure.Objective: Our purpose was to validate 3 new scales that grade small-bowel cleansing for CE.Design: Prospective, randomized, single-center study.Setting: Tertiary university hospital.Intervention: Five experienced capsule endoscopists read 40 CEs twice, separated by I month, to grade small-bowel cleansing on 3 scales-quantitative index (QI; 0-10), qualitative evaluation (QE; poor, fair, good, excellent), and overall adequacy assessment (OAA; inadequate, adequate). The QI and QE evaluated both the entire and distal small bowel. Investigators received no prior training in these scales.Main Outcome Measurements: Intraclass correlation coefficients to assess intraobserver (test-retest) and interobserver reliability.Patients: Forty patients who underwent I CE between June 2005 and May 2006 and who satisfied entry criteria.Results: Intraobserver reliability was moderate to substantial for the QI (0.60-0.66), moderate for the OAA (0.56), and fair to moderate for the QE (0.37-0.47). Interobserver scores were lower QI and OAA moderate (0.47-0-52, 0.41, respectively) and slight to fair for the QE (0.20-0.24). QI scores for the entire and distal small bowel were highly correlated for each reader (0.57-0.87), and distal small-bowel scores were lower by 1.3 points, indicating poorer cleansing (P = .001). A dichotomized QE of excellent/good versus fair/poor had moderate to Substantial intraobserver and interobserver reliability (0.58-0.66, 0.41-0.49, respectively). There was a strong and highly significant association among all 3 scales (P < .001 between QI and both QE and OAA).Conclusion: We have described and validated 3 scales for grading small-bowel cleansing for CE. An evaluation of small-bowel cleansing should be routinely incorporated into the CE report. (Gastrointest Endosc 2009;69:262-70.)