Simplified endoscopic mucosal assessment for crohn’s disease (sema-cd): external application and prognostic value definition

Abstract Background In 2022, the Simplified Endoscopic Mucosal Assessment for Crohn’s Disease (SEMA-CD) was created and internally validated, aiming to simplify endoscopic activity assessment in ileocolonoscopies for CD. This score was shown to be easier and faster to apply than previously used Simple Endoscopic Score for CD (SES-CD). In our investigation, we aimed to apply this score on a European population and to assess if its prognostic value was the same as SES-CD. Methods Longitudinal study of consecutive CD patients undergoing ileocolonoscopy for assessment of endoscopic activity. Patients with previous ileocecal resection were excluded. CD endoscopic activity was classified according to both SES-CD and SEMA-CD. A minimum follow-up period of 12 months was required. Treatment escalation, hospitalization and bowel resection were assessed during the follow-up period. Results The initial sample included 265 patients, with 61 being excluded for having previous ileocecal surgery. Final sample included 204 patients, 113 (54.9%) female, with a mean age of 43±14 years. SEMA-CD had a nearly-perfect correlation with SES-CD (r=0.998; p<0.001). SEMA-CD performed similarly to SES-CD in predicting treatment escalation (AUC=0.905 vs AUC=0.908), bowel resection (AUC=0.517 vs AUC=0.516), and hospitalization (AUC=0.605 vs AUC=0.610) (p>0.05). Optimal SEMA-CD cut-off predicting treatment escalation during the subsequent year was a SEMA-CD ≥2 (sensitivity 88%; specificity 86%). Conclusion In our sample, SEMA-CD perfectly correlated with SES-CD, having similar performances in predicting treatment escalation, surgery and hospitalization in CD patients. We first defined a SEMA-CD ≥2 as a possible guide to treatment escalation. Our study confirms SEMA-CD as a potentially helpful tool in CD patients’ follow-up.