Letter to the Editor
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2024; 30(10): 1466-1469
Published online Mar 14, 2024. doi: 10.3748/wjg.v30.i10.1466
Are we ready to use new endoscopic scores for ulcerative colitis?
Rodrigo Quera, Paulina Núñez F
Rodrigo Quera, Paulina Núñez F, Universidad de los Andes, Inflammatory Bowel Disease Program, Clinica Universidad de los Andes, Digestive Disease Center, Santiago 7600976, RM, Chile
Paulina Núñez F, Digestive Disease Center, Inflammatory Bowel Disease Program, Clínica Universidad de los Andes, Santiago 7620157, Chile
Paulina Núñez F, Department of Gastroenterology, Universidad de Chile-Hospital San Juan de Dios, Santiago 770123, Chile
Author contributions: Núñez F P and Quera R carried out the conception, made literature review; both authors wrote the letter, making critical revision and editing, and approved the final version.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Paulina Núñez F, MD, Assistant Professor, Digestive Disease Center, Inflammatory Bowel Disease Program, Clínica Universidad de los Andes, 2501 Plaza Avenue, Santiago 7620157, Chile. pnunez@clinicauandes.cl
Received: January 6, 2024
Peer-review started: January 6, 2024
First decision: January 16, 2024
Revised: January 23, 2024
Accepted: February 25, 2024
Article in press: February 25, 2024
Published online: March 14, 2024
Processing time: 67 Days and 19.4 Hours
Abstract

For ulcerative colitis (UC), the variability in inflammatory activity along the colon poses a challenge in management. The focus on achieving endoscopic healing in UC is evident, where the UC Endoscopic Index of Severity and Mayo Endoscopic Subscore are commonly used for evaluation. However, these indices primarily consider the most severely affected region. Liu et al recent study validates the Toronto Inflammatory Bowel Disease Global Endoscopic Reporting (TIGER) score offering a comprehensive assessment of inflammatory activity across diverse segments of the colon and rectum and a reliable index correlating strongly with UC Endoscopic Index of Severity and moderately with Mayo Endoscopic Subscore (MES). Despite recommendation, certain aspects warrant further investigation. Fecal calprotectin, an intermediate target, correlates with TIGER and should be explored. Determining TIGER scores defining endoscopic remission and response, evaluating agreement with histological activity, and assessing inter-endoscopist agreement for TIGER require scrutiny. Exploring the correlation between TIGER and intestinal ultrasound, akin to MES, adds value.

Keywords: Ulcerative colitis; Sigmoidoscopy; Colonoscopy; Score index

Core Tip: For ulcerative colitis (UC), the degree of inflammatory activity can vary along the length of the colon, ranging from the rectum to the proximal colon. Currently, achieving endoscopic healing is a long-term goal in the management of UC, with the UC Endoscopic Index of Severity score and Mayo Endoscopic Subscore being the most suggested indices to evaluate this target. However, both scores only consider the most severely affected area in their final assessment. Recently, the Toronto Inflammatory Bowel Disease Global Endoscopic Reporting score has shown its usefulness in determining the extent and severity of inflammatory activity across various segments of the colon and rectum. Despite this, there is no consensus regarding the endoscopic method (total colonoscopy or sigmoidoscopy) for evaluating the achievement of endoscopic healing in UC patients.