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Observational Study
, 80 (2), 269-76

Boston Bowel Preparation Scale Scores Provide a Standardized Definition of Adequate for Describing Bowel Cleanliness

Observational Study

Boston Bowel Preparation Scale Scores Provide a Standardized Definition of Adequate for Describing Bowel Cleanliness

Audrey H Calderwood et al. Gastrointest Endosc.


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.

Conflict of interest statement

Conflicts of Interests: D. Lieberman is the executive director of the Clinical Outcomes Research Initiative (CORI), a nonprofit organization supporting this study. This potential conflict of interest has been reviewed and managed by the Oregon Health & Science University and Veterans Affairs Conflict of Interest in Research Committee. The remaining authors have no conflicts of interest to disclose.


Figure 1
Figure 1
Sample video case asking participants to provide a recommendation for timing of next colonoscopy based on bowel cleanliness observed.
Figure 2
Figure 2
Flow diagram showing the colonoscopy examinations included in the analysis of the association between Boston Bowel Preparation Scale scores and timing of the next colonoscopy recommended. * Recommendation for no further colonoscopies due to age
Figure 3
Figure 3
Percentage of normal colonoscopy examinations in which 10-year follow-up was recommended stratified by total Boston Bowel Preparation Scale score.

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