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Background Few bowel preparation rating scales have been validated. Most were intended for comparing oral purgatives, failing to account for washing/suctioning by the endoscopist. This limits their utility in studies of colonoscopy outcomes such as polyp detection rates. Objective To develop a valid and reliable scale for use in colonoscopy outcomes research. Setting Academic medical center. Methods We developed the Boston Bowel Preparation Scale (BBPS), a 10-point scale assessing bowel preparation after all cleansing maneuvers are completed by the endoscopist. We assessed inter- and intra-observer reliability using video footage of colonoscopies viewed on two separate occasions by 22 clinicians. We then applied the BBPS prospectively during screening colonoscopies, comparing BBPS scores with clinically-meaningful outcomes including polyp detection rates and procedure times. Results The intra-class correlation coefficient (a measure of inter-observer reliability) for BBPS scores was 0.74. The weighted Kappa (a measure of intra-observer reliability) for scores was 0.77 (95% CI 0.66-0.87). During 633 screening colonoscopies, the mean (SD) BBPS score was 6.0 (1.6). Higher BBPS scores (≥5 versus <5) were associated with a higher polyp detection rate (40% vs 24%; p<0.02). BBPS scores were inversely correlated with colonoscope insertion (r = −0.16; p<0.003) and withdrawal (r = −0.23; p<0.001) times. Limitations Single-center study. Conclusions The BBPS is a valid and reliable measure of bowel preparation. It may be well-suited to colonoscopy outcomes research because it reflects the colon's cleanliness during the inspection phase of the procedure.

Background-Overweight and obese individuals are at increased risk for gastroesophageal reflux disease (GERD). An association between body mass index (BMI) and GERD symptoms among normal weight individuals has not been demonstrated.