Validation and Investigation of the Operating Characteristics of the Ulcerative Colitis Endoscopic Index of Severity

Jong, Djuna C. de; Löwenberg, Mark; Koumoutsos, Ioannis; Ray, Shuvra; Mawdsley, Joel; Anderson, Simon; Sanderson, Jeremy; Gecse, Krisztina; Ponsioen, Cyriel Y.; D’Haens, Geert R.; Irving, Peter M; Samaan, Mark A

doi:10.1093/ibd/izy325

Cited by 27 publications

(23 citation statements)

References 25 publications

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“…To our knowledge, we were the first to focus on the ability of the UCEIS, compared to the MES, to predict response to treatment and also the need for colectomy in a cohort of patients with moderate-to-severe disease with biological therapy. Endoscopic severe patterns of inflammation were described as MES = 3 and UCEIS = 6–8, as reported in previous studies [34].…”

Section: Discussionmentioning

confidence: 89%

“…The UCEIS thresholds, examined at the internal validation, should require further external forms of validation [12]. De Jong et al [34] proposed a UCEIS score of 4 or above as the endoscopic threshold to consider treatment escalation. Recently, another group used the same threshold to define active disease in a study investigating the correlation with fecal calprotectin [35].…”

Section: Discussionmentioning

confidence: 99%

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Role of Ulcerative Colitis Endoscopic Index of Severity (UCEIS) versus Mayo Endoscopic Subscore (MES) in Predicting Patients′ Response to Biological Therapy and the Need for Colectomy

et al. 2020

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Background: The main goal in the treatment of ulcerative colitis (UC) is to achieve mucosal healing. Despite being unvalidated, the most widely used scoring system is the Mayo endoscopic subscore (MES). However, the recently established and validated Ulcerative Colitis Endoscopic Index of Severity (UCEIS) represents an interesting alternative method in assessing endoscopic disease activity. Objective: Due to a lack of reliable prognostic factors, the aim of this study was to investigate the diagnostic accuracy of the UCEIS and the MES, in predicting response to biological therapy and the need for colectomy. Methods: We conducted a retrospective, uncontrolled, single-center study on UC patients with endoscopically active disease even with concomitant conventional and/or biological therapy, who had already started or had been changed a biological treatment. Results: Sixty-one UC patients were enrolled. At baseline, 71% were naive to biological therapies and 41% had an extensive colitis. At control time (median time of 11.5 months), MES and UCEIS scores significantly decreased from those at baseline (from 2.6 to 1.8 and 5 to 3.2, respectively, p < 0.001). UCEIS, but not MES, was found to be significantly associated with unresponsiveness to therapy (p = 0.040). Moreover, when UCEIS was ≥7, all patients underwent colectomy after a median time of 5 months (p < 0.001). Conclusion: UCEIS may be superior to MES because of its accuracy and predictive role. Therefore, UCEIS should be considered for use in daily clinical practice.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Role of Ulcerative Colitis Endoscopic Index of Severity (UCEIS) versus Mayo Endoscopic Subscore (MES) in Predicting Patients′ Response to Biological Therapy and the Need for Colectomy

et al. 2020

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“…Also, it has been demonstrated that UCEIS outperforms MES in predicting the medium- to long-term prognosis for UC with clinical remission and the need for escalation treatment. 12,13 UCEIS was also reported to predict corticosteroid treatment failure in acute severe colitis and assess the long-term response to anti-TNFα therapy. 14,15 Furthermore, UCEIS was also proved to be strongly correlated with patient-reported symptoms and minimally affected by clinical information.…”

Section: Introductionmentioning

confidence: 99%

The Degree of Ulcerative Colitis Burden of Luminal Inflammation score is superior to predicting medium- to long-term prognosis in patients with active ulcerative colitis

Chen

Yang

Fang

et al. 2020

Therap Adv Gastroenterol

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Aims: The endoscopic evaluation is crucial for the management and treatment of ulcerative colitis (UC). Currently, the Mayo Endoscopic Score (MES) and the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) are two major endoscopic score systems to evaluate the status of mucosal inflammation and disease activity. However, in both MES and UCEIS systems, the disease extent is not included. The Degree of Ulcerative Colitis Burden of Luminal Inflammation (DUBLIN) score is a simple clinical score which is calculated as a product of the MES (0–3) and the extent of disease (E1–E3). The objective of this study was to compare the correlation among DUBLIN, UCEIS and MES, and also investigate the clinical characteristics for predicting treatment failure in patients with active UC. Methods: Between March 2015 and April 2019, 172 patients who were previously diagnosed with UC and had undergone colonoscopy were recruited in this study. We retrospectively reviewed the endoscopic scores and clinical characteristics at the time of the colonoscopy and assessed the prognosis of the patients. Endoscopic response was defined as the decrease in MES ⩾1 grade. Results: DUBLIN showed significant correlation with MES ( r = 0.748) and partial Mayo score (pMayo) ( r = 0.707), and moderately correlated with CRP ( r = 0.590). UCEIS also showed strong correlation with MES ( r = 0.712) but moderate correlation with pMayo ( r = 0.609) and CRP ( r = 0.588). Compared with the UCEIS (cut-off value: 4; sensitivity: 75.73%), DUBLIN score (cut-off value: 4; sensitivity: 86.41%) showed higher diagnostic sensitivity than UCEIS score (McNemar test, p < 0.05). Furthermore, a multivariate analysis also revealed that DUBLIN ⩾4 was the independent factor for predicting treatment failure for UC ( p < 0.001, odds ratio: 1.547; 95% confidence interval: 1.32–1.88). Conclusion: The DUBLIN score shows superior diagnostic performances in terms of sensitivity value compared with the UCEIS. Moreover, multivariate analysis indicates that DUBLIN ⩾4 is an independent factor for predicting medium- to long-term treatment failure in active UC patients.

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“…Moreover, endoscopic scores, other than predicting clinical course and shortand long-term outcomes, could, at times, guide therapeutic decisions [19]. In this regard, a recent study by de Jong et al [20] highlighted this aspect by demonstrating that an UCEIS score ≥4 was significantly associated with treatment escalation, and this cutoff could, therefore, be used to support clinical decisions. On the other hand, endoscopic intestinal damage regression with the achievement of so-called "mucosal healing" (MH) has become an important "treat-to-target" parameter in UC, since it reduces the risk of exacerbations, hospitalization, colorectal cancer and colectomy [21][22][23][24].…”

Section: Discussionmentioning

confidence: 99%

Inter-Observer Agreement of a New Endoscopic Score for Ulcerative Colitis Activity: Preliminary Experience

et al. 2020

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Ulcerative colitis (UC) endoscopic scores translate mucosal damage into values standardizing image analysis. Due to potential limits of current endoscopic activity indexes, we have elaborated on a new score, the “Extended Mayo Endoscopic Score (EMES),” and evaluated its inter-observer agreement in a multicenter endoscopy team, comparing concordance with the Mayo subscore. Sixteen UC consecutive patients underwent follow-up colonoscopy. Recorded videos were anonymously loaded on a web platform. Thirteen expert endoscopists evaluated UC activity using both Mayo and EMES. EMES was described in every colon segment: erythema (0: absent, 1: mild, 2: moderate, 3: severe), vascular pattern (0: normal, 1: reduction, 2: disappearance), erosions and ulcers (0: absent, 1: from 1 to 5, 2: 6 to 10, 3: >10). Weighted Fleiss’ kappa with 95% confidence interval (CI) and p-value defined inter-rater agreement. Global inter-observer agreement of EMES was moderate (kappa = 0.56, 95% CI = 0.46–0.67, p < 0.001). The evaluation of each colonic segment showed moderate agreement for all segments: ascending (kappa = 0.46, 95% CI = 0.32–0.60, p < 0.001), transverse (kappa = 0.48, 95% CI = 0.29–0.67, p < 0.001); descending (kappa = 0.49, 95% CI = 0.35–0.64, p < 0.001), sigmoid (kappa = 0.52, 95% CI = 0.39–0.65, p < 0.001) and rectum (kappa = 0.55, 95% CI = 0.42–0.69, p < 0.001). Mayo subscore agreement was similar to global EMES (kappa = 0.53, 95% CI = 0.39–0.66, p = 0.001). Therefore, our report emphasizes the importance of assessing inter-observer agreement for EMES, but also for other known scoring systems, including the Mayo subscore.

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Validation and Investigation of the Operating Characteristics of the Ulcerative Colitis Endoscopic Index of Severity

Cited by 27 publications

References 25 publications

Role of Ulcerative Colitis Endoscopic Index of Severity (UCEIS) versus Mayo Endoscopic Subscore (MES) in Predicting Patients′ Response to Biological Therapy and the Need for Colectomy

Role of Ulcerative Colitis Endoscopic Index of Severity (UCEIS) versus Mayo Endoscopic Subscore (MES) in Predicting Patients′ Response to Biological Therapy and the Need for Colectomy

The Degree of Ulcerative Colitis Burden of Luminal Inflammation score is superior to predicting medium- to long-term prognosis in patients with active ulcerative colitis

Inter-Observer Agreement of a New Endoscopic Score for Ulcerative Colitis Activity: Preliminary Experience

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