The Boston Bowel Preparation Scale: Is It Already Being Used?

Colorectal cancer is one of the most prevalent malignancies worldwide [1]. Routine screening using colonoscopy has contributed to a significant decrease in both colorectal cancer incidence and mortality [2, 3]. The diagnostic accuracy of colonoscopy requires thorough visualization of the colonic mucosa, and, regardless of technological advances and endoscopists’ skills, an adequate bowel preparation is a vital factor to ensure a high-quality procedure. Poor bowel preparation is a major impediment to the effectiveness of colonoscopy as it can lead to missed lesions, incomplete procedures, prolonged cecal intubation and withdrawal times, and repeat procedures at intervals shorter than those recommended [4–7]. Accordingly, several major endoscopic societies, such as the European Society of Gastrointestinal Endoscopy (ESGE), the American Society of Gastrointestinal Endoscopy (ASGE), and the American College of Gastroenterology (ACG), recommend that every colonoscopy report should include an assessment of the quality of the bowel preparation, ideally after all cleansing maneuvers, like washing and suctioning of the fluid, have been completed [8–12]. Because, until recently, no bowel preparation quality assessment tool had been validated, endoscopists were advised to describe bowel preparation quality using subjective terms, such as “excellent,” “good,” “fair,” and “poor,” despite the lack of standardized definitions for these terms. Alternatively, endoscopists could classify bowel preparation quality as “adequate” if it allowed detection of polyps ≥5 mm in size or as “inadequate” if it did not fulfill this requirement [12]. Over the past decade, several scales have emerged in order to better evaluate the adequacy of bowel cleansing for research purposes, such as the Aronchick Scale, the Ottawa Bowel Preparation Scale, the Harefield Cleansing Scale, the Chicago Bowel Preparation Scale, and the Boston Bowel Preparation Scale (BBPS). Attempts to introduce these scales into clinical practice have been limited by the lack of large validation studies [12, 13]. The BBPS is a 9-point standardized rating scale developed at Boston University Medical Center (USA) that has been attracting worldwide attention. Unlike previous scales that assess bowel cleanliness encountered during