Comparison of Bowel Preparation Quality Scales Used in Randomized Controlled Trials of Patients Undergoing Colonoscopy
Bibliographic record
Abstract
Introduction: Adequate bowel preparation (BP) is critical for a successful colonoscopy. Inadequate BP can negatively impact adenoma detection rates, withdrawal time, and necessitate early repeat colonoscopy. Discrepancies in BP quality reporting exist across clinical trials due to the lack of a uniform quality scale. While validated BP quality scales such as the Aronchick scale, Ottawa scale, and Boston BP scale exist, some registration trials have used custom-made non-validated scales. The goal of this analysis is to compare BP quality scales from recent pivotal trials of BP agents. Methods: Three BP quality scales were identified from 8 clinical trials of 4 BP agents: sodium picosulfate and magnesium citrate (P/MC), oral sulfate solution (OSS), OSS and 2L polyethylene glycol solution (OSS+PEG), and 2L PEG plus ascorbic acid (PEG+AA). Responder or success criteria were obtained from each study and specific details regarding visibility of mucosa, remaining stool, and need for suctioning were compared. The minimal responder criterion for OSS and OSS+PEG trials allowed “small amounts of feces or fluid not interfering with the exam,” while in PEG+AA trials an A or B rating was classified as responder, requiring stool be fully displaceable allowing for complete visualization. P/MC trials required an “Excellent”/“Good” Aronchick scale rating for responders. A “Fair” Aronchick rating was classified as a nonresponder and defined as “>90% mucosal visibility, liquid or semisolid stool, and could be suctioned or washed.” To highlight the variability between the different scales, we performed a post hoc analysis reclassifying Aronchick responders as “Excellent”/“Good”/“Fair.” Results: Based on the nonresponder criteria of the OSS, OSS+PEG, and PEG+AA clinical trials, we reclassified responder in P/MC trials to include the “Fair” Aronchick rating. In the original studies, 84.2% and 83.0% of P/MC patients were classified as a responder using the “Excellent'/”Good” criterion, whereas responder rates for P/MC patients were 99.7% and 98.7% after realignment. Conclusion: Differences in BP quality scales create confusion when comparing responder rates between trials. The percent of Aronchick scale responders in the P/MC trials varied from 84.2% to 99.7% depending on how responder was defined. The use of validated BP quality scales with stringent scoring criteria, such as that defined as “Excellent/Good” in the Aronchick scale, would help clarify clinical trial data related to quality measurements and improve outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.170 | 0.283 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.010 | 0.015 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.001 | 0.003 |
| Scholarly communication | 0.004 | 0.004 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".