title: Clinical utility of a new endoscopic scoring system for Crohn's disease.
abstract: OBJECTIVE
  To evaluate the clinical value of the newly modified Simple Endoscopic Score for Crohn's disease (mSES-CD).
  
  
  METHODS
  Seventy-six Crohn's disease (CD) patients who underwent transanal double balloon endoscopy (DBE) in our hospital between 2003 and 2012 were retrospectively reviewed. DBE is defined as small intestinal endoscopy using two attached balloons. We included patients with stenosis which hampered passage of the scope and those who underwent DBE with observation for at least 80 cm from the ileocecal valve. Our new mSES-CD assesses the endoscopic activity of two consecutive small intestinal segments located 0-40 cm and 40-80 cm from the ileocecal valve by DBE, in addition to the activity of four colorectal segments. To compare the usefulness of mSES-CD with SES-CD, we similarly divided the patients into two groups according to total mSES-CD score (low disease activity group, < 4; high disease activity group, ≥ 4). The clinical value of mSES-CD in predicting clinical outcome in patients with CD was evaluated using the occurrence of surgery after DBE as an endpoint.
  
  
  RESULTS
  Median age of the 76 CD patients was 36 years (range, 16-71). Thirty-nine patients had stenosis which hampered passage of the DBE to 80 cm on the proximal side from the ileocecal valve. Median evaluable length of small intestine by DBE was 80 cm (range, 3-200). A total of 74 patients had one or more small intestinal lesions detected by DBE, of which 62 (83.8%) were within 80 cm of the ileocecal valve on the proximal side. Only two patients (2.7%) with proximal-side lesions more than 80 cm from the ileocecal valve did not have lesions within 80 cm. Patients with high mSES-CD scores showed significantly shorter surgery-free survival than those with low scores (P < 0.05). In contrast, surgery-free survival did not significantly differ between the low and high SES-CD groups (P > 0.05). Multivariate analysis by a Cox proportional hazards model identified mSES-CD as an independent factor for surgery-free survival.
  
  
  CONCLUSIONS
  mSES-CD is useful in evaluating the risk of surgery-free survival in patients with CD.
authors.affiliation: Kazuhiro Morise, Takafumi Ando, Osamu Watanabe, Masanao Nakamura, Ryoji Miyahara, Osamu Maeda, Kazuhiro Ishiguro, Hidemi Goto, Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Morise
authors.affiliation: Kazuhiro Morise, Takafumi Ando, Osamu Watanabe, Masanao Nakamura, Ryoji Miyahara, Osamu Maeda, Kazuhiro Ishiguro, Hidemi Goto, Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Ando
authors.affiliation: Kazuhiro Morise, Takafumi Ando, Osamu Watanabe, Masanao Nakamura, Ryoji Miyahara, Osamu Maeda, Kazuhiro Ishiguro, Hidemi Goto, Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Watanabe
authors.affiliation: Kazuhiro Morise, Takafumi Ando, Osamu Watanabe, Masanao Nakamura, Ryoji Miyahara, Osamu Maeda, Kazuhiro Ishiguro, Hidemi Goto, Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan.
authors.forename: Masanao
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Kazuhiro Morise, Takafumi Ando, Osamu Watanabe, Masanao Nakamura, Ryoji Miyahara, Osamu Maeda, Kazuhiro Ishiguro, Hidemi Goto, Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan.
authors.forename: Ryoji
authors.initials: R
authors.lastname: Miyahara
authors.affiliation: Kazuhiro Morise, Takafumi Ando, Osamu Watanabe, Masanao Nakamura, Ryoji Miyahara, Osamu Maeda, Kazuhiro Ishiguro, Hidemi Goto, Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Maeda
authors.affiliation: Kazuhiro Morise, Takafumi Ando, Osamu Watanabe, Masanao Nakamura, Ryoji Miyahara, Osamu Maeda, Kazuhiro Ishiguro, Hidemi Goto, Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Ishiguro
authors.affiliation: Kazuhiro Morise, Takafumi Ando, Osamu Watanabe, Masanao Nakamura, Ryoji Miyahara, Osamu Maeda, Kazuhiro Ishiguro, Hidemi Goto, Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Hirooka
authors.affiliation: Kazuhiro Morise, Takafumi Ando, Osamu Watanabe, Masanao Nakamura, Ryoji Miyahara, Osamu Maeda, Kazuhiro Ishiguro, Hidemi Goto, Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan.
authors.forename: Hidemi
authors.initials: H
authors.lastname: Goto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003424:Crohn Disease / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D058582:Double-Balloon Enteroscopy; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000473:pathology* / Q000601:surgery; D007564:Japan; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
keywords: Crohn’s disease; Double balloon endoscopy; Modified Simple Endoscopic Score; Mucosal healing; Surgery-free survival