Simple Endoscopic Score for Crohn's Disease (SES-CD)
SES-CD • Simplified Crohn's Index
Segmental Scores (0-12 per segment)
Apply the segmental endoscopy scores for ulceration and surface area to visualize the overall SES-CD index.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Endoscopic quantification of inflammatory activity in Crohn's Disease (CD)
Standardized scoring of mucosal healing following biological therapy
Primary outcome measure for most modern CD clinical trials
To guide "Treat-to-target" strategies aimed at endoscopic remission
SES-CD vs. CDEIS
The SES-CD (2004) was developed to simplify the overly complex CDEIS (1989). It uses 4 easily observable variables across 5 colonic segments, making it practical for routine clinical use.
Section 2
Formula & Logic
The 4 Parameters (0–3 pts each)
01
Size of Ulcers: None (0), Aphthous (1), Large 0.5–2cm (2), or Very Large > 2cm (3).
02
Ulcerated Surface: Percentage of the segment surface that is ulcerated.
03
Affected Surface: Percentage of the segment surface that is inflamed (non-ulcerated).
04
Presence of Narrowing: None (0), Single passable (1), Multiple passable (2), or Non-passable (3).
Assessment Segments
Calculated for each of the 5 segments: Ileum, Right colon, Transverse, Left colon, and Rectum. The total score is the sum of all 5 (Range 0–56).
Severity Categories (Broad)
Score ≤ 2
Endoscopic Remission
Score 3–6
Mild Activity
Score 7–15
Moderate Activity
Score > 15
Severe Activity
Section 3
Pearls/Pitfalls
Defining "Endoscopic Remission"
While historical trials used a score < 3 for remission, the STRIDE-II consensus now favors "Mucosal Healing," defined as the complete absence of ulcers (an SES-CD ulcer subscore of 0 in all segments).
The Non-passable Stricture
A narrowing that the scope cannot pass (Grade 3) is a high-risk finding for imminent mechanical obstruction. If this occurs in the setting of low-level inflammation (fibrotic stricture), it may suggest the need for surgical resection or balloon dilation rather than more biologics.
Clinical Pearls
Aphthous ulcers (pts 1) are defined as being < 0.5 cm in diameter
Inter-observer agreement is excellent ($r > 0.9$), especially for the "ulcer" subscores
A 50% reduction in SES-CD from baseline is considered an "Endoscopic Response"
Section 4
Next Steps
Management Action
01
SES-CD > 7 and rising: Failure of current therapy; Switch mechanism (e.g., Anti-TNF to Anti-IL12/23).
02
SES-CD ≤ 2: Target met; Continue maintenance and monitor CRP/Calprotectin.
Complementary CD Tools
CDAI (Activity Index)
Lémann Index (Damage Score)
Rutgeerts Score (Post-op)
Section 5
Evidence Appraisal
The Foundational Paper
Development and validation of a new, simplified endoscopic activity score for Crohn's disease: the SES-CD.
Daperno M et al. • Gastrointestinal Endoscopy. 2004;60(4):502-8. The seminal study establishing the score.
Derived from a multi-center collaboration. The investigators recognized that the older CDEIS was so difficult to calculate it was being ignored in clinical practice, creating a barrier to objective treat-to-target management.
