Lecture on Endoscopic Scoring Systems in IBD

Opening Remarks

• Speaker: Sean from Deran
• Session: Endoscopic Scoring Systems in Inflammatory Bowel Disease (IBD)
• Chair: Prof. Sandy Thompson (expected to join later)
• Context: Assessment and management of IBD with endoscopic scoring

Importance of Endoscopy in IBD

• Gold standard for diagnosis and assessment of mucosal disease activity
• Prognosis and monitoring for dysplasia
• Assessing response to clinical therapy

Historical Development of Endoscopic Scoring Systems

• 1940s: Rigid sigmoidoscopy
• 1950s: True Love and Witts with simple scoring system for colitis
• 1964: Baron Index
• 1987: Mayo Endoscopic Scoring Index for colitis
• 2012: Ulcerative Colitis Endoscopic Index of Severity
• Crohn’s Disease: Development of various indices
  • Crohn’s Disease Endoscopic Index of Severity (CDEIS)
  • Simple Endoscopic Score for Crohn’s Disease (SES-CD)
  • Rutgeerts Score for postoperative recurrence

Targets of Therapy in IBD

• Aim: Prevent or limit intestinal injury or disability
• STRIDE (Selecting Therapeutic Targets in IBD):
  • STRIDE I & II: Set goals for management and follow-up
  • Short, Intermediate, and Long-term targets defined

Scoring Systems for Ulcerative Colitis (UC)

• Baron Score (1978): Three-point scale, mainly mucosal bleeding
• Sutherland Index (1983): Four-point scale, mucosal appearance
• Rachmilewitz Index (1989): Four variables, cumulative score
• Modified Baron Score (2005): Five-point scale adds nodularity and friability
• Mayo Endoscopic Score (1987; modified 2007): Common, four-point scale
  • Healing: Mayo Score 0 or 1
• Ulcerative Colitis Endoscopic Index of Severity (UCEIS 2012): Addresses bleeding and appearance
  • Healing: UCEIS Score < 1
• Ulcerative Colitis Colonoscopic Index of Severity (UCCIS): Segmented assessment

Mayo Endoscopic Score vs UCEIS Comparison

• Mayo: Easy to remember, widely used
• UCEIS: More objective, clearer prognostic value
• Healing definitions and severity well detailed

Scoring Systems for Crohn’s Disease (CD)

• Crohn’s Disease Endoscopic Index of Severity (CDEIS): Detailed, multiple variables
  • Remission: Reduction by 3-5 points
• Simplified Endoscopic Score for Crohn’s Disease (SES-CD): Four variables, easier
  • Remission: SES-CD < 3, Healing: SES-CD = 0
• Rutgeerts Score: Postoperative recurrence
  • Grades I0 to I4

Capsule Endoscopy Scores

• Lewis Score: Bow divided into three parts, complex arithmetic
• Capsule Endoscopy Crohn’s Disease Activity Index (CECDAI/N Score): Defined subgroups

Report Requirements for Endoscopy in IBD

• Describe disease distribution, activity, and margins
• Differentiate between Crohn’s and UC, if possible
• Identify complications like strictures and neoplasia

Concluding Thoughts

• Standardized scoring systems and universal adoption critical for personalized medicine in IBD

Q&A Session Highlights

• Frequency of Endoscopies: Balancing need for scoring with resource constraints
• AI in Endoscopy: Ongoing development, importance of video/photo documentation
• Training and Implementation: Importance of familiarization with scoring systems for accurate evaluation