Categorising Endoscopic Severity of Crohn’s Disease Using the Modified Multiplier SES-CD [MM-SES-CD]

Abstract

Background and aims Current endoscopic scoring indices such as the Simple Endoscopic Score for Crohn’s Disease (SES-CD) quantify the degree of mucosal inflammation in Crohn’s disease (CD) but lack prognostic potential. The Modified Multiplier of the SES-CD (MM-SES-CD) quantifies the endoscopic burden of CD and can be accessed online (https://www.mcmasteribd.com/mm-ses-cd). This analysis aims to establish MM-SES-CD thresholds that classify CD endoscopic burden into inactive/very mild, mild, moderate, and severe disease based on the probability of achieving endoscopic remission (ER) on active therapy at one-year. Methods This post-hoc analysis included pooled data from three CD clinical trials (n=350 patients, baseline SES-CD ≥3 with ulceration). Disease category severity was determined using the maximum Youden Index. Achievement of ER between severity categories were compared using chi-square tests. Time to clinical remission (CR) was compared using Kaplan-Meier survival curves. Results MM-SES-CD severity categories were established as very mild/remission (score <14), mild (≥14 to <31), moderate (≥31 to <45), and severe (≥45), which were predictive of one-year ER (50%, 30.3%, 21.7%, 8.8% respectively p<0.001). Lower MM-SES-CD scores had numerically higher rates of one-year CR, and time to one-year CR was superior to those with higher scores (p=0.0492). MM-SES-CD thresholds for achieving one-year ileal ER among 75 patients with isolated ileal disease were established as mild (score <14), moderate (≥14 to <33), and severe (≥33), which were predictive of one-year ER (66.7%, 33.3%, 13.3%, respectively p=0.027). Conclusions We have established numerical MM-SES-CD cut-offs that categorize endoscopic disease severity and have demonstrated that they are prognostic for one-year ER and CR.

Endoscopic severity and classification of lesions with pan-enteric capsule endoscopy and ileocolonoscopy in ileocolonic Crohn’s disease

“…Recently, the SES-CD score was further developed for a better ability to predict endoscopic healing while on medical treatment (MM-SES-CD) 16 25 . The MM-SES-CD is calculated from the SES-CD score by assigning multipliers based on the number of ulcerated segments and different prognostic values for each parameter in each segment.…”

Development and validation of multiparametric models based on computed tomography enterography to determine endoscopic activity and surgical risk in patients with Crohn's disease: A multi-center study

“…Several endoscopic severity scoring systems, including the Crohn's Disease Endoscopic Index of Severity (CDEIS), have been applied in daily practice and accurately correlated with biochemical and clinical disease markers [ 4 , 5 ]. In addition, several new endoscopic scores have been developed, such as the Simple Endoscopic Score for Crohn's Disease (SES-CD), which is associated with the standard CDEIS and enables retrospective collection of information on mucosal status [ 6 , 7 ].…”

“…Ileocolonoscopy induces discomfort, and repeated colonoscopies are not well tolerated, which also limits its application in the long-term follow-up of patients with CD [ 9 ]. Furthermore, endoscopic evaluation with various scoring systems is considered complicated and time-consuming in daily practice [ 6 , 7 ]. All these limitations require an alternative approach to assess mucosal activity in patients with CD.…”

Editorial: Moving towards prognostic endoscopic scoring in IBD

“…However, there is no consensus within the field on the most favourable system. There has been increasing attention paid to the importance of scores that represent intermediate‐term outcomes and long‐term prognostic information including the Ulcerative Colitis Severity Index and the Modified Multiplier of the SES‐CD 8–10 . We are beginning to move towards robust IBD scoring systems that provide prognostic value and are simple enough to use in day‐to‐day clinical practice.…”