Implementation of the simple endoscopic activity score in crohn's disease

Abstract

Simple Endoscopic Score for Crohn's Disease (SES-CD) was developed as an attempt to simplify Crohn's Disease Endoscopic Index of Severity (CDEIS). Since it was constructed from CDEIS, SES-CD performs comparably but also carries similar limitations. Several studies have utilized SES-CD scoring to describe disease severity or response to therapy. Some of them used SES-CD score as a continuous variable while others utilized certain cutoff values to define severity grades. All SES-CD cutoff values reported in published clinical trials were empirically selected by experts. Although in most of the studies that used SEC-CD scoring to define disease severity, a score <3 reflected inactive disease, no study is using score 0 to predefine inactivity. Studies applying SES-CD to define response to treatment used score 0. There is no optimal SES-CD cut-off for endoscopic remission. The quantification of mucosal healing using SES-CD scoring has not been standardized yet. As the definition of mucosal healing by SES-CD is unset, the concept of deep remission is also still evolving. Serum and fecal biomarkers as well as new radiologic imaging techniques are complementary to SES-CD. Current practice as well as important changes in endoscopy should be taken into consideration when defining SES-CD cutoffs. The optimal timing of SES-CD scoring to assess mucosal healing is not defined yet. To conclude, SES-CD represents a valuable tool. However, a consensus agreement on its optimal use is required.

One‐year clinical outcomes with biologics in Crohn's disease: transmural healing compared with mucosal or no healing

“…Then, the specific SES‐CD cut‐off value for mucosal healing definition has not been yet standardised. Most authors used a cut‐off value <2 to define the endoscopic remission (the same cut‐off used in the present study), others used a SES‐CD = 0, that is a very difficult endpoint to obtain in clinical practice . Further studies are needed in order to understand prognostic differences between a SES‐CD = 0 and <2.…”

Associations Among Mucosal and Transmural Healing and Fecal Level of Calprotectin in Children With Crohn’s Disease

“…9 Repeated ileocolonoscopic evaluation of the mucosa is therefore increasingly used in clinical practice, with varying thresholds of the SESCD to define mucosal healing, frequently using SESCD <3, or absence of ulcerations. [10][11][12][13] However, endoscopy can neither evaluate the deep layers of the intestinal wall nor visualize most of the small bowel. These shortcomings can be addressed by concurrent use of magnetic resonance enterography (MRE), [14][15][16] which can utilize the Magnetic Resonance Index of Activity (MaRIA) score in adults, [16][17][18][19] but also by a radiologist's global assessment (RGA) of MRE inflammation.…”

Associations between quantitative evaluation of bowel wall microvascular flow by contrast‐enhanced ultrasound and indices of disease activity in Crohn's disease patients using both bolus and infusion techniques

“…The most recent colonoscopy, which was performed within a month before the CEUS and before starting or escalating any treatment, was used to determine the baseline endoscopic disease activity and to calculate the SES‐CD score (Simple Endoscopic Score for Crohn's disease) . A total SES‐CD score <3 without the presence of erosions defined inactive disease endoscopically …”

“…17,18 A total SES-CD score <3 without the presence of erosions defined inactive disease endoscopically. 19 From the TIC, we calculated the peak signal intensity (PI) and the area under curve (AUC), which is related to the regional blood volume for both bolus and infusion studies ( Figure 2).…”