Chronological Review of Endoscopic Indices in Inflammatory Bowel Disease

Abstract

Inflammatory bowel disease (IBD) is considered a chronic condition characterized by mucosal or transmural inflammation in the gastrointestinal tract. Endoscopic diagnosis and surveillance in patients with IBD have become crucial. In addition, endoscopy is a useful modality in estimation and evaluation of the disease, treatment results, and efficacy of treatment delivery and surveillance. In relation to these aspects, endoscopic disease activity has been commonly estimated in clinical practices and trials.<br/> At present, many endoscopic indices of ulcerative colitis have been introduced, including the Truelove and Witts Endoscopy Index, Baron Index, Powell-Tuck Index, Sutherland Index, Mayo Clinic Endoscopic Sub-Score, Rachmilewitz Index, Modified Baron Index, Endoscopic Activity Index, Ulcerative Colitis Endoscopic Index of Severity, Ulcerative Colitis Colonoscopic Index of Severity, and Modified Mayo Endoscopic Score. Endoscopic indices have been also suggested for Crohn's disease, such as the Crohn's Disease Endoscopic Index of Severity, Simple Endoscopic Score for Crohn's Disease, and Rutgeerts Postoperative Endoscopic Index. However, most endoscopic indices have not been validated owing to the complexity of their parameters and inter-observer variations. Therefore, a chronological approach for understanding the various endoscopic indices relating to IBD is needed to improve the management.

Keywords: Colitis, ulcerative; Colonoscopy; Crohn disease; Endoscopic index.

Fig. 1.

Endoscopic images according to the Mayo Endoscopic Score. (A) Grade 0 (normal or inactive disease), (B) grade 1 (mild disease), (C) grade 2 (moderate disease), and (D) grade 3 (severe disease).

Fig. 2.

Endoscopic images according to the Ulcerative Colitis Endoscopic Index of Severity. For vascular pattern, (A) 1, (B) 2, and (C) 3; for bleeding, (D) 1, (E) 2, (F) 3, and (G) 4; and for erosions and ulcers, (H) 1, (I) 2, (J) 3, and (K) 4.

Fig. 3.

Endoscopic images according to the Crohn’s Disease Endoscopic Index of Severity. (A) Superficial ulceration and (B) deep ulceration.

Fig. 4.

Endoscopic images according to the Simple Endoscopic Score for Crohn’s Disease. For the size of ulcers, (A) aphthous ulcers, (B) large ulcers, and (C) very large ulcers.

Fig. 5.

Endoscopic images according to the Crohn’s Disease Endoscopic Index of Severity (CDEIS) and Simple Endoscopic Score for Crohn’s Disease (SES-CD). For ulcerated and affected surfaces, (A) CDEIS (score 10.0) and SES-CD (score 3.0) and for ulcerated impassable stenosis, (B) CDEIS (score 3.0) and SES-CD (score 3.0).

Fig. 6.

Chronicle of endoscopic indices in inflammatory bowel disease. CDEIS, Crohn’s Disease Endoscopic Index of Severity; SES-CD, Simple Endoscopic Score for Crohn’s Disease; UCEIS, Ulcerative Colitis Endoscopic Index of Severity.