**6. SES – CD score for Crohn's Disease**

Being mucosal healing a fundamental end-point for treatment of CD, the necessity to define a simple score for the endoscopic activity of disease has emerged in the last few years [1].

Such a score results from the addition of single evaluations: ulcer's dimension, extension of the ulcerated surface, presence and severity of stricture [1].

From the validation studies, SES – CD comes out to be simple, reproducible and easy to be used for CD; a strong relation among the score value, the clinical parameters of the disease (pCDAI) and blood levels of CRP have been identified [1].

The correlation between SES –CD and pCDAI is statistically significant, despite the limitation due to the fact that many extra intestinal manifestations are clinically manifested but are not necessarily accompanied by any mucosal involvement [1].

Other possible limitations of SES-CD are the presence of fistulas (for the evaluation of which endoscopy does not represent the best diagnostic tool), underestimation of strictures (due to the functional nature of the classification being used; what is considered is, in fact, the


Baron and Mayo scores are the two principle indexes for the endoscopic grading of UC [3]. As regards the major histological alterations in UC, they are distorted with the disappearance of mucous glandular architecture and inflammatory infiltration of the crypts. They also have a villi-like profile of the mucosal surface, a high grade alteration of the mucosal architecture, Paneth cells metaplasia and a decrease of the inflammation and mucosal alteration grade

*Relative*: hyperacute situations with associated risk of severe complications such as

The risk of complications is equal to 0.3% per procedure and decreases to 0.05% in the

Conservative therapy is used in cases of asymptomatic perforations or in localized peritonitis, in the absence of signs and symptoms of sepsis. In any more severe situations, the operating

Splenyc rupture is a very rare complication, that manifests with hypovolemia, pain at the shoulder or abdominal pain appearing within 24 hours after the performance of ileum-

Equally rare is also pancreatitis caused by the rupture of the pancreas within the procedure

Being mucosal healing a fundamental end-point for treatment of CD, the necessity to define a simple score for the endoscopic activity of disease has emerged in the last few years [1]. Such a score results from the addition of single evaluations: ulcer's dimension, extension of

From the validation studies, SES – CD comes out to be simple, reproducible and easy to be used for CD; a strong relation among the score value, the clinical parameters of the disease

The correlation between SES –CD and pCDAI is statistically significant, despite the limitation due to the fact that many extra intestinal manifestations are clinically manifested

Other possible limitations of SES-CD are the presence of fistulas (for the evaluation of which endoscopy does not represent the best diagnostic tool), underestimation of strictures (due to the functional nature of the classification being used; what is considered is, in fact, the

approach consists in the resection of the intestinal segment and anastomosis [4-5].




absence of polipectomy [4].

colonoscopy.

[4-5].


previously ulcerated areas



from the upper to the lower colonic tract are seen [9].

**5. Contraindications to endoscopic procedure** 

perforation and abundant bleeding.

**6. SES – CD score for Crohn's Disease** 

the ulcerated surface, presence and severity of stricture [1].

(pCDAI) and blood levels of CRP have been identified [1].

but are not necessarily accompanied by any mucosal involvement [1].

*Absolute:* toxic megacolon, suspect of intestinal perforation, shock [3]

capacity of the endoscope to overcome the stricturing tract) and overestimation of nonspecific lesions (at this level the endoscopic experience of the operator is determinant) [1].

The addition prefigures the evaluation of 5 pre-determined ileum-colonic segments: ileum (explorable portion), right colon (comprehending the ileum-cecal valve, cecum, ascendant colon, hepatic flexure), transverse colon, left colon (comprehending descendant colon, sigma, rectum-sigmoid junction), rectum. For each segment, the evaluation of four endoscopic variables is prefigured: presence of ulcers, extension of ulcerated surface, extension of the surface with lesions, presence of stenosis. For each variable, a score ranging from 0 to 3 is assigned to each segment [1].

The classification of the ulcers for the SES-CD addition is based on their dimensions; therefore the extension of the ulcerated segment is evaluated attributing a score of 3 to those cases with a surface involvement exceeding 30%: such a proportion of extension is thus considered as the most severe pattern, since a major extension has no additional effect on the severity of symptoms [1].

The classification of strictures for SES-CD is both descriptive and functional; in fact it is based on the capacity of the endoscope to overcome a segmental luminal narrowing [1].
