Clean Colon Software Program (CCSP), Proposal of a standardized Method to quantify Colon Cleansing During Colonoscopy: Preliminary Results

Abstract

Background and study aims: Neoplastic lesions can be missed duringcolonoscopy, especially when cleansing is inadequate. Bowel preparationscales have significant limitations and no objective and standardizedmethod currently exists to establish colon cleanliness duringcolonoscopy. The aims of our study are to create a software algorithmthat is able to analyze bowel cleansing during colonoscopies and tocompare it to a validate bowel preparation scale.Patients and methods: A software application (the Clean Colon SoftwareProgram, CCSP) was developed. Fifty colonoscopies were carried out andvideo-recorded. Each video was divided into 3 segments: cecum-hepaticflexure (1st Segment), hepatic flexure-descending colon (2nd Segment)and rectosigmoid segment (3rd Segment). Each segment was recorded twice,both before and after careful cleansing of the intestinal wall. A scorefrom 0 (dirty) to 3 (clean) was then assigned by CCSP. All the videoswere also viewed by four endoscopists and colon cleansing wasestablished using the Boston Bowel Preparation Scale. Interclasscorrelation coefficient was then calculated between the endoscopists andthe software.Results: The cleansing score of the prelavage colonoscopies was 1.560.52and the postlavage one was 2,08 +/- 0,59 (P<0.001) showing anapproximate 33.3% improvement in cleansing after lavage. Right colonsegment prelavage (0.99 +/- 0.69) was dirtier than left colon segmentprelavage (2.07 +/- 0.71). The overall interobserver agreement betweenthe average cleansing score for the 4 endoscopists and the softwarepre-cleansing was 0.87 (95% CI, 0.84-0.90) and post-cleansing was 0.86(95% CI, 0.83-0.89).Conclusions: The software is able to discriminate clean from non-cleancolon tracts with high significance and is comparable to endoscopistevaluation.