Crohn's Disease Endoscopic Index of Severity (CDEIS)
CDEIS Rubric • Crohn's Endoscopic Index
Segment
Deep Ulcer
Superficial
Surface %
Ulcer %
Ileum
Ascending
Transverse
Descending
Rectum
Stenosis Present?
Populate the endoscopic findings for all five segments to visualize the Crohn's severity index.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Objective quantification of mucosal inflammatory activity in Crohn's disease.
Monitoring response to induction therapy (the "Mucosal Healing" endpoint).
Research-grade endoscopic reporting in IBD clinical trials.
Evaluating disease recurrence at the ileocolonic anastomosis.
High-Authority Endpoint
The CDEIS is considered the academic "gold standard" for endoscopic scoring. It was the first validated score to correlate endoscopic findings with the clinical risk of surgery and disease relapse.
Section 2
Formula & Logic
The 5 Segments Evaluated
01
Terminal Ileum
02
Right Colon (Ascending/Caecum)
03
Transverse Colon
04
Left Colon (Descending/Sigmoid)
05
Rectum
Segment Scores
For each segment, the endoscopist records the presence of "Deep Ulcers" (12 points), "Superficial Ulcers" (6 points), the "Surface Area Involved" by disease (10cm visual analogue scale), and the "Surface Area Involved by Ulceration" (10cm VAS).
Scoring Formula
CDEIS = (Sum of segment scores / Number of segments inspected) + Stenosis points
Severity Thresholds
< 3
Endoscopic Remission
3–8
Mild Disease
9–12
Moderate Disease
> 12
Severe Disease
Section 3
Pearls/Pitfalls
Why CDEIS is Hard to Beat
Despite the development of the "Simple Endoscopic Score for CD" (SES-CD), the CDEIS remains the most granular instrument. It specifically weights deep vs. superficial ulceration, which is a key predictor of whether a patient will respond to corticosteroids or require biological therapy.
Mucosal Healing (MH)
Achievement of endoscopic remission (CDEIS < 3) is associated with prolonged "drug-free" remission and a significant reduction in the need for total abdominal colectomy.
Implementation Barrier
The complexity of calculating the weighted segment averages and the use of Visual Analogue Scales (VAS) makes it time-consuming for routine endoscopy. SES-CD is often preferred for daily clinical reporting.
Section 4
Next Steps
Therapeutic Targets
01
CDEIS > 8: Treat-to-target — intensive follow-up required (e.g., re-eval at 6 months after starting Anti-TNF).
02
CDEIS < 3: Remission — maintain current therapy; consider "monotherapy" if on combo therapy (judgement call).
Complementary Scoring
SES-CD (Simple Endoscopic Score)
Rutgeerts Score (Post-op Recurrence)
CDAI (Clinical Activity Index)
Section 5
Evidence Appraisal
The GETAID Development
Development and prospective validation of an endoscopic index of severity for Crohn's disease. Groupe d'Etudes Thérapeutiques des Affections Inflammatoires du Tube Digestif (GETAID).
Mary JY et al. • Gut. 1989;30(7):983-9. The foundational development and validation study.
Developed by the prestigious GETAID group in France, led by Professor Robert Modigliani. These researchers were among the first to argue that clinical remission (CDAI) was not enough, and that "true" control of Crohn's required evidence of mucosal healing.
