Suggested Instructions for the Chicago Bowel Preparation Scale

Suggested Instructions for the Chicago Bowel Preparation Scale

Chicago Bowel Preparation Scale (CBPS)

0=Unprepared colon segment with stool that cannot be cleared (>15% of the mucosa not seen)

5=Portion of mucosa in segment seen after cleaning, but up to 15% of the mucosa not seen due to retained material

10=Minor residual material after cleaning, but mucosa of segment generally well seen

11=Entire mucosa of segment well seen after washing

12=Entire mucosa of segment well seen before washing (suctioning of liquid allowed)

CBPS Right Colon:0 5 10 11 12

CBPS Transverse Colon:0 5 10 11 12

CBPS Left Colon: 0 5 10 11 12

CBPS Fluid Whole Colon:3=Lots of fluid (300 cc) 2=Moderate fluid (151-300 cc)

1=Minimal fluid (51-150 cc) 0=Little fluid (≤50 cc)

1)Before the study begins, the raters should watch a video such as media.bmc.org/Media/BostonBowelPreparationScale.wmv as a calibration exercise and the results should be discussed among the raters.A lower limit on total scores should be considered to prevent one very poor colon preparation from having an undue influence on the outcome of the study. The authors suggest a lower limit of 10.

2)Immediately after each colonoscopy, a rating form (sample shown above) should be completed. The total score is calculated by adding the scores from all three colon segments. The fluid score is reported separately.

3)A colon segment is rated no higher than 11 if any irrigation fluid is used to clean away residual fecal material including foamy bubblesor liquid from that segment. Ratings of 12 are allowed if the irrigation fluid is used only to remove blood from a polypectomy site.

4)A segment is rated no higher than 10 if minor residual fecal material remains after cleaning maneuvers.

5)A segment is rated no higher than 5 if enough residual material remains so that a small polyp might be missed.

6)Any segment not seen due to technical difficulties advancing the colonoscope around the colon should not be rated. Any colon segment that has been completely removed surgically should not be rated. A colon segment is rated even if only a portion of it is visualized.

7)Any segment not seen because the more distal colon was too dirty to pass receives a grade of 0.

8)The anatomic borders of each colon segment are as follows: the right colon is from the proximal cecum to the mid-hepatic flexure; the transverse colon is from the mid-hepatic flexure to the mid-splenic flexure; and the left colon is from the mid-splenic flexure to the distal rectum. Raters should use their best judgment to identify these anatomic landmarks.

9)The total volume of fluid in the whole colon should be estimated by the rater and exclude any fluid injected into the colon. Each rater should place a suction bottle (with accurate volume markings) between the vacuum source and the colonoscope to help make these estimates until the rater feels comfortable making the estimates without the suction bottle (the authors suggest at least 20 cases). Be sure the suction bottle is emptied of any fluid used to test the colonoscope before it is introduced.The fluid injected into the colon is not always recovered in the suction bottle and the net fluid suctioned from the colon often underestimates the total volume of fluid in the colon.

10)After the study is complete, the mean score for each colon segment should be calculated from all colons that had that segment rated. The mean total score should be calculated by adding themean scores for each of the 3 colon segments; otherwise, unrated segments will bias the total score. The mean fluid score is reported separately and should include all colons rated.

New Bowel Preparation Scale for Colonoscopy --- MD Questionnaire

Patient Name: ______Patient Study ID #: ______

Indication: Screening h/o Polyps h/o Colon Cancer FH Colon Neoplasia Rectal Bleeding

Long Standing IBD Anemia Other: ______

Findings: ______MD: G R H

Was the Cecum Reached? Yes or NoIf No, Extent of Colonoscopy: ______

Ottawa Preparation Scale (OPS)

4=Inadequate (Solid stool not cleared with washing and suctioning)

3=Poor (Necessary to wash and suction to obtain a reasonable view)

2=Fair (Necessary to suction liquid to adequately view segment)

1=Good (Minimal turbid fluid in segment)

0=Excellent (mucosal detail clearly visible)

OPS Right Colon: 4 3 2 1 0

OPS TV/Descending Colon: 4 3 2 1 0

OPS Sigmoid Colon/Rectum: 4 3 2 1 0

OPS Fluid Whole Colon:2=lots of fluid 1=moderate fluid 0=little fluid

Boston Bowel Preparation Scale (BBPS)

0=Unprepared colon segment with stool that cannot be cleared

1=Portion of mucosa in segment seen after cleaning, but other areas not seen due to retained material

2=Minor residual material after cleaning, but mucosa of segment generally well seen

3=Entire mucosa of segment well seen after washing

BBPS Right Colon: 0 1 2 3

BBPS TV Colon: 0 1 2 3

BBPS Left Colon: 0 1 2 3

Chicago Bowel Preparation Scale (CBPS)

0=Unprepared colon segment with stool that cannot be cleared (15+% of the mucosa not seen)

5=Portion of mucosa in segment seen after cleaning, but up to 15% of the mucosa not seen due to retained material

10=Minor residual material after cleaning, but mucosa of segment generally well seen

11=Entire mucosa of segment well seen after washing

12=Entire mucosa of segment well seen before washing (suctioning of liquid allowed)

CBPS Right Colon:0 5 10 11 12

CBPS TV Colon: 0 5 10 11 12

CBPS Left Colon: 0 5 10 11 12

CBPS Fluid Whole Colon:3=Lots of fluid (300+ cc) 2=Moderate fluid (151-300 cc)

1=Minimal fluid (51-150 cc) 0=Almost no fluid (less than 50 cc)

Did you consider the preparation adequate for a good quality colonoscopy? Yes or No

New Bowel Preparation Scale for Colonoscopy --- Diane Questionnaire

Patient Name: ______Patient Study ID #: ______

Age: ______Sex: M or FRace: C AA H Other

Bowel Prep: Gatorade/PEG Other ______Scheduled Starting Time: ______

Ottawa Preparation Scale (OPS)

4=Inadequate (Solid stool not cleared with washing and suctioning)

3=Poor (Necessary to wash and suction to obtain a reasonable view)

2=Fair (Necessary to suction liquid to adequately view segment)

1=Good (Minimal turbid fluid in segment)

0=Excellent (mucosal detail clearly visible)

OPS Right Colon: 4 3 2 1 0

OPS TV/Descending Colon: 4 3 2 1 0

OPS Sigmoid Colon/Rectum: 4 3 2 1 0

OPS Fluid Whole Colon:2=lots of fluid 1=moderate fluid 0=little fluid

Boston Bowel Preparation Scale (BBPS)

0=Unprepared colon segment with stool that cannot be cleared

1=Portion of mucosa in segment seen after cleaning, but other areas not seen due to retained material

2=Minor residual material after cleaning, but mucosa of segment generally well seen

3=Entire mucosa of segment well seen after washing

BBPS Right Colon: 0 1 2 3

BBPS TV Colon: 0 1 2 3

BBPS Left Colon: 0 1 2 3

Chicago Bowel Preparation Scale (CBPS)

0=Unprepared colon segment with stool that cannot be cleared (15+% of the mucosa not seen)

5=Portion of mucosa in segment seen after cleaning, but up to 15% of the mucosa not seen due to retained material

10=Minor residual material after cleaning, but mucosa of segment generally well seen

11=Entire mucosa of segment well seen after washing

12=Entire mucosa of segment well seen before washing (suctioning of liquid allowed)

CBPS Right Colon:0 5 10 11 12

CBPS TV Colon: 0 5 10 11 12

CBPS Left Colon: 0 5 10 11 12

CBPS Fluid Whole Colon:3=Lots of fluid (300+ cc) 2=Moderate fluid (151-300 cc)

1=Minimal fluid (51-150 cc) 0=Little fluid (less than 50 cc)

Did you consider the preparation adequate for a good quality colonoscopy? Yes or No

Fill out the Following Table ONLY after completing the above questionnaire.