Development and validation of a new, simplified endoscopic activity score for Crohn's disease: the SES-CD.
BACKGROUND
Healing of mucosal lesions appears to offer significant benefit and is an important end point in clinical trials of treatment for Crohn's disease. The only validated endoscopic activity score at present is the Crohn's Disease Endoscopic Index of Severity, which is complicated and time consuming and, hence, is unsuitable for routine use. The aim of this study was to develop and to prospectively validate a simpler endoscopic score of disease activity, the Simple Endoscopic Score for Crohn's Disease.


METHODS
Selected endoscopic parameters (ulcer size, ulcerated and affected surfaces, stenosis) were scored from 0 to 3. Reproducibility for scoring of these parameters was evaluated through 71 examinations in which the endoscopist was paired with an observer. The simplest score (Simple Endoscopic Score for Crohn's Disease) that was highly correlated with both the Crohn's Disease Endoscopic Index of Severity and Crohn's Disease Activity Index was derived for 70 patients and then was prospectively validated in 121 different patients with Crohn's disease.


RESULTS
The interobserver agreement for all selected endoscopic variables was excellent (kappa coefficient 0.791-1.000). Based on multiple linear regression, the Simple Endoscopic Score for Crohn's Disease resulted in the sum of the scores for ulcer size, ulcerated surface, affected surface, and luminal narrowing. In the validation phase of the study, a strong correlation was demonstrated for the Simple Endoscopic Score for Crohn's Disease with Crohn's Disease Endoscopic Index of Severity (r = 0.920). In addition, the Simple Endoscopic Score for Crohn's Disease was correlated to clinical parameters and serum C-reactive protein level.


CONCLUSIONS
Simple Endoscopic Score for Crohn's Disease is a simple, reproducible, and easy-to-use endoscopic scoring system for Crohn's disease.
Daperno
Marco
M
Gastroenterology Unit, Ospedale Mauriziano Umberto I, Torino, Italy.
D'Haens
Geert
G
Van Assche
Gert
G
Baert
Filip
F
Bulois
Philippe
P
Maunoury
Vincent
V
Sostegni
Raffaello
R
Rocca
Rodolfo
R
Pera
Angelo
A
Gevers
Annemie
A
Mary
Jean-Yves
JY
Colombel
Jean-Frédéric
JF
Rutgeerts
Paul
P
D000328:Adult; D002097:C-Reactive Protein / Q000032:analysis; D003424:Crohn Disease / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014456:Ulcer / Q000473:pathology
D002097:C-Reactive Protein