Colonoscopy has emerged as the preferred screening test for colorectal cancer because of its superior adenoma detection rates compared to other screening modalities. The increasing demand for colonoscopy necessitates efficient utilization of colonoscopy by optimization of high quality examinations. The diagnostic accuracy of colonoscopy requires thorough visualization of the colonic mucosa, making bowel preparation a vital element of the procedure and a key quality indicator. Despite its importance, there is currently no uniform, valid way of assessing bowel preparation quality. We have previously developed a novel bowel preparation rating scale, the Boston Bowel Preparation Scale, that is unique in its application during the withdrawal phase of colonoscopy after all cleaning maneuvers have been performed. Another important feature of the Boston Bowel Preparation Scale is its ability to preserve differences in cleanliness between the colonic segments by using individual scores for the right, transverse, and left colon. Our preliminary studies performed at a single academic institution have validated this scale and while its initial performance appears to be promising, the ability to generalize the utility of our results is currently limited. The candidate for this award proposes to educate providers across the country in different practice settings working through a national consortium of endoscopic practices, the Clinical Outcomes Research Initiative (CORI), on use of the Boston Bowel Preparation Scale and demonstrate its reliability, construct validity, and utility as a predictor of polyp detection. Such a tool would contribute significant value to standardizing clinical practice, ensuring quality in colonoscopy, and facilitating research surrounding colonoscopy outcomes. The successful completion of this project will improve our ability to quantify missed pathology rates and to make evidence-based recommendations regarding appropriate surveillance intervals for exams with varying degrees of bowel cleanliness. In addition, this project will allow the candidate to gain invaluable experience in study design, database analysis, and other epidemiologic methods. The candidate will complete a Master's of Science in Epidemiology degree as part of this award. The research will be performed under the mentorship of Dr. Paul Schroy, a well-established investigator in health-services research;in addition, major collaborations will involve CORI and its principal investigator, Dr. David Lieberman. At the completion of the project, the candidate will have gained the experience necessary to enable her to become an effective independent heath-services researcher.

Public Health Relevance

The diagnostic accuracy of colonoscopy as a screening method for colorectal cancer requires thorough visualization of the colonic mucosa, making bowel preparation a vital element of the procedure and a key quality indicator in colonoscopy. At present, there is no uniform, valid way of assessing bowel preparation quality, leading to inconsistencies in follow-up recommendations and hampering colonoscopy outcomes research. The widespread use of a valid, reliable bowel preparation scale will improve our ability to quantify missed pathology rates during colonoscopy and to make evidence-based recommendations regarding appropriate surveillance intervals.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Clinical Investigator Award (CIA) (K08)
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Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
Program Officer
Podskalny, Judith M,
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Boston Medical Center
United States
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Calderwood, Audrey H; Enestvedt, Brintha K; DeVivo, Rebecca et al. (2016) Impact of gender on requests for ASGE leadership assignments. Gastrointest Endosc 83:730-3
Calderwood, Audrey H; Lasser, Karen E; Roy, Hemant K (2016) Colon adenoma features and their impact on risk of future advanced adenomas and colorectal cancer. World J Gastrointest Oncol 8:826-834
Long, Michelle T; Leszczynski, Ania; Thompson, Katherine D et al. (2015) Female authorship in major academic gastroenterology journals: a look over 20 years. Gastrointest Endosc 81:1440-1447.e3
Calderwood, Audrey H; Thompson, Katherine D; Schroy 3rd, Paul C et al. (2015) Good is better than excellent: bowel preparation quality and adenoma detection rates. Gastrointest Endosc 81:691-699.e1
Calderwood, Audrey H; Logan, Judith R; Zurfluh, Michael et al. (2014) Validity of a Web-based educational program to disseminate a standardized bowel preparation rating scale. J Clin Gastroenterol 48:856-61
Kwah, Joann; Schroy 3rd, Paul C; Jacobson, Brian C et al. (2014) Whites and blacks have similar risk of metachronous advanced colorectal neoplasia. Dig Dis Sci 59:2264-71
ASGE Ensuring Safety in the Gastrointestinal Endoscopy Unit Task Force; Calderwood, Audrey H; Chapman, Frank J et al. (2014) Guidelines for safety in the gastrointestinal endoscopy unit. Gastrointest Endosc 79:363-72
Calderwood, Audrey H; Schroy 3rd, Paul C; Lieberman, David A et al. (2014) Boston Bowel Preparation Scale scores provide a standardized definition of adequate for describing bowel cleanliness. Gastrointest Endosc 80:269-76
Calderwood, Audrey H; Bacic, Janine; Kazis, Lewis E et al. (2013) Association between self-reported depression and screening colonoscopy participation. J Ambul Care Manage 36:345-55
Sinner, Moritz F; Wang, Na; Fox, Caroline S et al. (2013) Relation of circulating liver transaminase concentrations to risk of new-onset atrial fibrillation. Am J Cardiol 111:219-24

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