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. 2024 Nov;86(4):608-619.
doi: 10.18999/nagjms.86.4.608.

A newly proposed endoscopic score system to evaluate the entire small bowel and predict the prognosis in Crohn's disease

Hitoshi Tanaka  1 , Masanao Nakamura  2 , Takeshi Yamamura  1 , Keiko Maeda  1 , Tsunaki Sawada  2 , Eri Ishikawa  1 , Takashi Hirose  2 , Kota Uetsuki  2 , Tadashi Iida  1 , Yasuyuki Mizutani  1 , Kentaro Yamao  1 , Takuya Ishikawa  1 , Yoji Ishizu  1 , Kazuhiro Furukawa  1 , Takashi Honda  1 , Genta Uchida  3 , Hiroki Kawashima  1
Affiliations

A newly proposed endoscopic score system to evaluate the entire small bowel and predict the prognosis in Crohn's disease

Hitoshi Tanaka et al. Nagoya J Med Sci. 2024 Nov.

Abstract

Small bowel stenosis in patients with Crohn's disease leads to abdominal symptoms and can affect prognosis. The Simple Endoscopic Score for Crohn's Disease for the large bowel has been applied to the small bowel; however, stenosis scoring may be overestimated since it has a long diameter. This retrospective study aimed to devise a new endoscopic scoring system including the small bowel and evaluate whether it predicts the prognosis of Crohn's disease. The study included 103 patients with Crohn's disease at our hospital. We modified the Simple Endoscopic Score for Crohn's Disease and proposed a new scoring system; the modified applied Simple Endoscopic Score for Crohn's Disease was created by subtracting one point for stricture from the Simple Endoscopic Score for Crohn's Disease. Receiver operating characteristic curve analysis was performed to assess the accuracy of the modified applied score for Crohn's disease in predicting disease worsening within 1 year. Results were validated using the log-rank test. For the modified applied score, the area under the receiver operating characteristic curve for disease worsening within 1 year in 57 cases was 0.850. When the cutoff score was set to 9 points, the sensitivity and specificity were 72.7% and 80.6%, respectively. The log-rank test showed a significant difference (P = 0.027) in the risk of worsening within 1 year between the low (<9 points) and high (≥9 points) score groups. Thus, a higher modified applied Simple Endoscopic Score for Crohn's Disease may be associated with a significantly increased risk of disease worsening within 1 year.

Keywords: Crohn’s disease; balloon-assisted endoscopy; prognosis; scoring; small bowel.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Fig. 1
Fig. 1
Flow diagram of the study
Fig. 2
Fig. 2
ROC curves for scores in the training cohort ROC: receiver operating characteristic CRP: C-reactive protein CDAI: Crohn’s Disease Activity Index SES-CD: Simple Endoscopic Score for Crohn’s Disease MASES-CD: modified applied Simple Endoscopic Score for Crohn’s Disease
Fig. 3
Fig. 3
Distribution of 57 cases assessed by the MASES-CD and applied SES-CD in the training set Fig. 3A: Distribution of 57 cases assessed by the MASES-CD in the training set. Fig. 3B: Distribution of 57 cases assessed by applied SES-CD in the training set. SES-CD: Simple Endoscopic Score for Crohn’s Disease MASES-CD: modified applied Simple Endoscopic Score for Crohn’s Disease
Fig. 4
Fig. 4
A case of point dissociation between applied SES-CD and MASES-CD SES-CD: Simple Endoscopic Score for Crohn’s Disease MASES-CD: modified applied Simple Endoscopic Score for Crohn’s Disease
Fig. 5
Fig. 5
Kaplan–Meier scores for exacerbation within 1 year stratified by MASES-CD MASES-CD: modified applied Simple Endoscopic Score for Crohn’s Disease
Fig. 6
Fig. 6
ROC curves for scores in the validation cohort ROC: receiver operating characteristic SES-CD: Simple Endoscopic Score for Crohn’s Disease MASES-CD: modified applied Simple Endoscopic Score for Crohn’s Disease
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