Original articleClinical endoscopyValidation of the Harefield Cleansing Scale: a tool for the evaluation of bowel cleansing quality in both research and clinical practice
Section snippets
Background
The first validated scale to be widely used was developed for a clinical trial by Aronchick et al.9 Although the Aronchick Scale is a significant step forward to standardized assessment, it is nonetheless limited. First, it requires the user to make quantitative assessments of the percentage of bowel mucosa visible—an assessment that is likely to be subject to between-user variability. Second, the cleanliness score is based on a global assessment of the entire bowel, with no provision for
Methods
This study compared the HCS with the Aronchick Scale, based on expert assessments of video recordings of colonoscopies carried out as part of a clinical trial evaluating 2 different bowel preparation formulations.
The Aronchick scale is a global assessment of bowel cleansing efficacy, categorizing results into 1 of 5 grades according to the criteria outlined in Table 1. Although not formally part of the original Aronchick approach, the grade also can be condensed to a binary outcome
Correlation and agreement between scales
Assessments of cleansing efficacy were carried out by a group of 3 experienced gastroenterologists (“experts”) who were not otherwise involved in the clinical trial. Video recordings of each colonoscopy were reviewed by the experts, who were blinded to the form of bowel preparation in use and who then reached a consensus view on the bowel cleansing quality by using both HCS and Aronchick scales. Where there was disagreement as to the appropriate score, a majority decision was made. In addition
Correlation between scales
Of 337 patients in the study, 323 had expert scores available for the comparison of the HCS and Aronchick Scale. A total of 328 had scores available for investigator-applied HCS and the expert-applied Aronchick Scale, whereas 321 had scores available for the comparison of investigator-applied versus expert-applied HCS. Table 3 shows results for the 3 assessments.
For the primary parametric comparison of expert-applied HCS versus the expert-applied Aronchick Scale by using the Pearson
Discussion
The objective of this study was formal validation of the HCS against the Aronchick global scale by using video recordings of colonoscopies carried out within 2 clinical trials. Overall, the results demonstrated that the HCS is a sensitive and specific tool, with high levels of consistency versus the reference standard. For the purposes of this analysis, all available investigator and expert assessments of colon cleansing were used. The primary analysis was based on the evaluation of preparation
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Nurse-led reinforced education by mobile messenger improves the quality of bowel preparation of colonoscopy in a population-based colorectal cancer screening program: A randomized controlled trial
2022, International Journal of Nursing StudiesCitation Excerpt :Only “excellent” or “good” bowel preparation were considered as adequate in this study. Different from previous literature (Halphen et al., 2013), we used a more stringent criterion for the definition of adequate bowel preparation. We consider “fair” bowel preparation as inadequate because average-risk individuals who have “fair” bowel preparation and no adenoma detected in their screening colonoscopy are recommended to have an earlier surveillance in five years (instead of ten years) in our local practice.
Improving the tolerability and safety of 1-L polyethylene glycol plus low-dose ascorbic acid for bowel preparation in a healthy population: a randomized multicenter clinical trial
2022, Gastrointestinal EndoscopyCitation Excerpt :Next, high-definition EGD and colonoscopy (260 and 290 series; Olympus America, Center Valley, Pa, USA) were performed to assess bowel cleansing. The primary outcome was the efficacy of bowel cleansing, determined using the 5-point (0-4) Harefield Cleansing Scale (HCS) in the right-sided colon (cecum and ascending colon), transverse colon, descending colon, sigmoid colon, and rectum.15 The overall HCS grade was categorized as follows: A, all segments with a score of 3 or 4; B, at least 1 segment with a score of 2 but no segment scoring <2; C, at least 1 segment with a score of 1 but no segment scoring <1; and D, at least 1 segment with a score of 0.
Measuring bowel preparation adequacy in colonoscopy-based research: review of key considerations
2020, Gastrointestinal EndoscopyImproved high-quality colon cleansing with 1L NER1006 versus 2L polyethylene glycol + ascorbate or oral sulfate solution
2019, Digestive and Liver DiseaseCitation Excerpt :No guidelines address high-quality cleansing, but a growing body of evidence now suggests that adenoma detection rates are associated with CRC rates and that detection of polyps, adenomas, and sessile or serrated polyps may increase with high-quality colon cleansing [6,11–17]. The Harefield Cleansing Scale (HCS) is a validated scale for bowel cleansing assessment [18]. Successful bowel preparation means that the least clean segment has, at most, only residual opaque liquid or semi-solid stool left that is fully removable with appropriate suction (score 2) [18].
DISCLOSURE: M. Halphen is a full-time employee of Norgine, Ltd. D. Heresbach is a consultant for Norgine, Ltd, Aptalis, and MedPass and a speaker for Mauna Kea Technology and Wilson-Cook, France and received project sponsorship from Ferring SA. H.-J. Gruss and J. Belsey are consultants for Norgine, Ltd. No other financial relationships relevant to this publication were disclosed.
If you would like to chat with an author of this article, you may contact Dr Belsey at [email protected].