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A review of endoscopic scoring systems and their importance in a treat-to-target approach in inflammatory bowel disease (with videos)

Published:November 28, 2019DOI:https://doi.org/10.1016/j.gie.2019.11.032
      Endoscopic assessment is currently the criterion standard for the diagnosis and assessment of mucosal disease activity, prognosis and monitoring for dysplasia, and assessment of response to therapy. Wider appreciation of the potential disconnect between symptoms and objective measures of disease activity and evidence that uncontrolled inflammation may lead to progressive intestinal injury and irreversible bowel damage with adverse events has led to the concept of treating to target. Treating to target is defined as treating patients with high risk for disease progression early to prevent or limit intestinal injury or disability. Endoscopic remission (mucosal healing) has emerged as a key goal of therapy. Although there are no currently validated definitions of endoscopic mucosal remission, the use of endoscopic scoring systems add uniformity and objectivity and aid standardization with reporting of mucosal appearance, augmenting clinical decision making. A plethora of scoring systems exist to define activity, response, and remission in both Crohn’s disease and ulcerative colitis. In this review, we discuss the most commonly used endoscopic scoring systems and proposed definitions of response and remission, and how they can be integrated into a treat-to-target approach to optimize patient outcomes.

      Abbreviations:

      CD (Crohn’s disease), CDEIS (Crohn’s Disease Endoscopic Index of Severity), CI (confidence interval), IBD (inflammatory bowel diseases), ICC (intraclass correlation coefficient), IOIBD (International Organisation for the Study of Inflammatory Bowel Diseases), MCS (Mayo Clinic Score), MES (Mayo Endoscopic Subscore), MMES (Modified Mayo Endoscopic Score), REACT (Randomised Evaluation of an Algorithm for Crohn’s Treatment), SES-CD (Simple Endoscopic Score for Crohn’s Disease), UC (ulcerative colitis), UCEIS (Ulcerative Colitis Endoscopic Index of Severity)
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      • Erratum
        Gastrointestinal EndoscopyVol. 92Issue 1
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          In the article that appeared in the April issue of Gastrointestinal Endoscopy, “A review of endoscopic scoring systems and their importance in a treat-to-target approach in inflammatory bowel disease (with videos)” (Limdi JK, Picco M, Farraye FA. Gastrointest Endosc 2020;91:733–45), under the heading ENDOSCOPIC SCORING SYSTEMS IN ULCERATIVE COLITIS, there was an error in the reporting of UCEIS scoring. It should have stated:
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