Clin Endosc.  2022 Jul;55(4):480-488. 10.5946/ce.2022.108.

Endoscopic activity in inflammatory bowel disease: clinical significance and application in practice

• Kim KO

• KMID: 2531939
• DOI: http://doi.org/10.5946/ce.2022.108

Abstract

Endoscopy is vital for diagnosing, assessing treatment response, and monitoring surveillance in patients with inflammatory bowel disease (IBD). With the growing importance of mucosal healing as a treatment target, the assessment of disease activity by endoscopy has been accepted as the standard of care for IBD. There are many endoscopic activity indices for facilitating standardized reporting of the gastrointestinal mucosal appearance in IBD, and each index has its strengths and weaknesses. Although most endoscopic indices do not have a clear-cut validated definition, endoscopic remission or mucosal healing is associated with favorable outcomes, such as a decreased risk of relapse. Therefore, experts suggest utilizing endoscopic indices for monitoring disease activity and optimizing treatment to achieve remission. However, the regular monitoring of endoscopic activity is limited in practice owing to several factors, such as the complexity of the procedure, time consumption, inter-observer variability, and lack of a clear-cut, validated definition of endoscopic response or remission. Although experts have recently suggested consensus-based definitions, further studies are needed to define the values that can predict long-term outcomes.

Keyword

Endoscopy; Disease activity; Inflammatory bowel diseases; Mucosal healing

Figure

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  Fig. 1. Endoscopic features of each descriptor in ulcerative colitis endoscopic index of severity.

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  Fig. 2. Rutgeerts score for postoperative Crohn's disease (i2a and i2b by modified Rutgeerts score)

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  Fig. 3. Suggested algorithm for endoscopic assessment and application in practice. CRP, C-reactive protein; CD, Crohn's disease; UC, ulcerative colitis; SES-CD, Simple Endoscopic Score for Crohn's Disease; CDEIS, Crohn's Disease Endoscopic Index of Severity; UCEIS, Ulcerative Colitis Endoscopic Index of Severity.

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