Boston Bowel Preparation Scale scores provide a standardized definition of adequate for describing bowel cleanliness

BackgroundEstablishing 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.ObjectiveTo determine whether Boston Bowel Preparation Scale (BBPS) scores could serve as a standard definition of adequacy.DesignCross-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.SettingThe Clinical Outcomes Research Initiative.PatientsAverage-risk patients attending screening colonoscopy.InterventionsColonoscopy.Main Outcome MeasurementsRecommended follow-up intervals among average-risk, screening colonoscopies without polyps stratified by BBPS scores.ResultsWe 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.LimitationsRetrospective study.ConclusionBBPS 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.