Adequate bowel preparation is crucial for optimal visualisation and lesion detection and remains a key determinant of colonoscopy quality [1, 2]. Up to one-quarter of colonoscopies are conducted with inadequate bowel preparation, leading to reduced diagnostic yield and detection of nonpolypoid flat lesions, prolonged procedure time and an increased burden of repeat colonoscopies [2, 3].

Several validated scales exist for the assessment of bowel preparation quality, however, an area of unmet need is validated scores for patients with inflammatory bowel disease (IBD), where endoscopy is essential to diagnosis, disease assessment, management and cancer surveillance. The presence of strictures, severe inflammation and insufficient bowel preparation may present a unique challenge to colonoscopy quality in IBD. Additionally, various adverse predictors of poor bowel preparation have been identified in IBD patients [4-6]. There is a clear need for robust and reproducible colonoscopy quality control measures in this sub-population [7].

Solitano et al. evaluated the performance of four existing bowel preparation quality instruments—Boston Bowel Preparation Scale (BBPS), a modified BBPS (mBBPS), Harefield Cleansing Scale, and Bowel Cleansing Assessment Scale—in 50 endoscopy videos with Crohn's disease (CD) [8]. Their findings demonstrated ‘moderate’ to ‘substantial’ inter-rater and intra-rater reliability, and high correlation coefficients between instruments and the visual analogue scale. An important finding is that all instruments performed well in terms of overall reliability and the authors concluded that instrument selection for use in clinical practice should be based on familiarity and local practice.

This is an important study to support the use of these instruments as reliable and valid measures of bowel preparation quality in CD—particularly in those with active luminal disease, with 72.5% of the procedures having an SES-CD score > 3. Areas for further exploration include the instruments' ease of use, and the degree of ambiguity in interpreting the scores for each instrument. These factors were not discussed in this paper, however, would be highly relevant in clinical practice and informing consensus guidelines. Furthermore, the observed numerical differences in correlation scores would be of interest to explore in further large studies.

Important study limitations include the small sample size, which makes it challenging to comment on the applicability of these findings to specific CD subgroups. We look forward to further studies evaluating the reliability of quality scales particularly in penetrating, stricturing, and perianal fistulising CD cohorts with active proctitis. The cohort heterogeneity presents another limitation in applying these data to the general CD population. For instance, assessing colon preparation scores in a cohort that includes many patients with isolated ileal disease (14.3% of procedures) introduces interpretative complexity. There may also be differences in target bowel preparation quality depending on the procedure indication, such as cancer surveillance compared to disease assessment.

In conclusion, this study provides support for the use of existing bowel preparation quality instruments in CD. Further studies are required to address the limitations related to sample size and subgroup applicability.

充分的肠道准备对于最佳可视化和病变检测至关重要，并且仍然是结肠镜检查质量的关键决定因素 [1， 2]。多达四分之一的结肠镜检查是在肠道准备不足的情况下进行的，导致诊断率和非息肉样扁平病变的检出率降低，手术时间延长，重复结肠镜检查的负担增加 [2， 3]。

有几种经过验证的量表可用于评估肠道准备质量，但是，一个未满足需求的领域是炎症性肠病 （IBD） 患者的验证评分，其中内窥镜检查对于诊断、疾病评估、管理和癌症监测至关重要。狭窄、严重炎症和肠道准备不足的存在可能对 IBD 的结肠镜检查质量构成独特的挑战。此外，已在 IBD 患者中确定了肠道准备不良的各种不良预测因素 [4-6]。在这个亚群中，显然需要稳健且可重复的结肠镜质量控制措施 [7]。

Solitano 等人在 50 个克罗恩病 （CD） 内窥镜视频中评估了四种现有肠道准备质量仪器的性能——波士顿肠道准备量表 （BBPS）、改良 BBPS （mBBPS）、Harefield 清洁量表和肠道清洁评估量表 [8]。他们的研究结果表明，评估者之间和评估者内部的可靠性为“中等”到“相当高”，并且工具与视觉模拟量表之间存在高相关系数。一个重要的发现是，所有仪器在整体可靠性方面都表现良好，作者得出结论，用于临床实践的仪器选择应基于熟悉程度和当地实践。

这是一项重要的研究，支持使用这些仪器作为 CD 肠道准备质量的可靠和有效的衡量标准——特别是在患有活动性管腔疾病的患者中，72.5% 的手术具有 SES-CD 评分 > 3。需要进一步探索的领域包括乐器的易用性，以及解释每种乐器的乐谱时的歧义程度。本文未讨论这些因素，但这些因素在临床实践中高度相关，并为共识指南提供信息。此外，观察到的相关分数的数值差异将在进一步的大型研究中进行探索。

重要的研究局限性包括样本量小，这使得评论这些发现对特定 CD 亚组的适用性具有挑战性。我们期待进一步的研究评估质量量表的可靠性，特别是在伴有活动性直肠炎的穿透性、狭窄性和肛周瘘管 CD 队列中。队列异质性在将这些数据应用于一般 CD 人群时存在另一个限制。例如，在包括许多孤立性回肠疾病患者 （14.3% 的手术） 的队列中评估结肠准备评分会引入解释复杂性。根据手术适应症，例如癌症监测与疾病评估相比，靶肠道准备质量也可能存在差异。

总之，本研究为 CD 中使用现有的肠道准备质量仪器提供了支持。需要进一步的研究来解决与样本量和亚组适用性相关的局限性。