A Segmental Bowel Prep Scale for a Screening Colonoscopy and a New Reporting System

Introduction: The diagnostic accuracy of quality colonoscopy requires thorough visualization of the entire colonic mucosa, making bowel preparation a vital element of the procedure. Failure to sufficiently cleanse the colon prior to colonoscopy may lead to incomplete and more frequent procedures, increase the chances of complications and missed lesions which leads to both patient and physician dissatisfaction. Suboptimal preparation is a major barrier to fulfill the criterias for a quality colonoscopy. In research studies, the most widely used bowel preparation scales are -, Boston Bowel Prep Scale (BBPS), Ottawa Scale and the Aronchick Scale. These scales, score based on three large segments, and give a cumulated score. To be more precise, We propose to divide the colon in six segments- Rectum-R, Sigmoid-S, Descending- D, Transverse-T, Ascending-A, Cecum-C). Methods: The evaluation involves the rating of six anatomical segments of the colon (rectum, sigmoid, descending colon, transverse colon, ascending colon and cecum) on the 5 point Arya Bowel Prep Score (ABPS) (Table 1). A score of 4 and 3 were “Adequate.” A combination of geographical clues and segmental length were considered to identify the individual segments (Table 2). To assess the reliability of ABPS, we trained 4 gastroenterologists and 3 fellows with the description as well as the endoscopic images corresponding to the 5-point scale (0-4). Ten colonoscopy videos were randomly selected and these DVDs were then evaluated and scored by them separately.Table 1: Arya bowel prep scaleTable 2: Identification landmarks of different segments and their intraclass correlationResults: The results of the colon prep were reported as Rx, Sx, Dx, Tx, Ax, Cx where “x” represents the prep score in that individual segment. The validation results for the 4 attending and 3 fellows are shown in Table 2. The same scale was used successfully in a pilot study and a randomized clinical trial to test the efficacy of Shudh Colon Cleanse (SCC) with a conventional PEG based prep. Conclusion: Two-thirds of colorectal malignancies are localized in the left colon and rectum. This scale considers the incidence of colon cancer based on the location so that more emphasis will be laid on a particular smaller segment while scoring the bowel prep. Segmental scores might also help to explain any interval cancer in retrospect. A cumulative score for the entire colon can be misleading as the quality of bowel prep varies through different segments.

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