Crohn’s disease (CD) often recurs after ileocolic resection, requiring reliable endoscopic assessment. While the Rutgeerts score is standard, its limitations highlight the need for alternatives. Simplified Endoscopic Score for Crohn’s Disease (SES-CD) and Modified Multiplier SES-CD (MM-SES-CD) assess both ileal and colonic disease, potentially providing a more comprehensive evaluation. This study evaluates their predictive value for postoperative disease progression compared to Rutgeerts score.

Longitudinal study of consecutive CD patients undergoing ileocolonoscopy for postoperative surveillance. Receiver operating characteristic (ROC) curve analyses compared Rutgeerts, SES-CD, and MM-SES-CD scores for predicting disease progression within one year after ileocolonoscopy. Multivariate logistic regression assessed score cutoffs, adjusting for confounders. Disease progression was defined as a composite endpoint, including clinical recurrence (Harvey-Bradshaw Index ≥4), therapy intensification, CD-related hospitalization, endoscopic balloon dilation, or surgery.

A total of 81 patients (48±13 years; 55.6% female) with 128 ileocolonoscopies were included. Regarding Montreal classification, 37 (45.7%) patients had ileal and 44 (54.3%) ileocolonic disease; 9 (11.1%) patients had nonstricturing, nonpenetrating disease, 35 (43.2%) structuring and 37 (45.7%) penetrating disease. Nineteen (23.5%) had perianal disease. The mean time between surgery and ileocolonoscopy was 133±83months.

Disease progression occurred in 44 (34.4%) cases at one-year follow-up. Rutgeerts score demonstrated fair accuracy (AUC 0.73; 95% CI 0.64-0.80), which was similar to SES-CD (AUC 0.72; 95%CI 0.63-0.79) and MM-SES-CD (AUC 0.72; 95%CI 0.63-0.80).

The optimal thresholds for predicting disease progression were SES-CD>4 (sensitivity 70.45%; specificity 69.05%) and MM-SES- CD>17 (sensitivity 59.09%; specificity 77.38%). However, comparing scores cutoffs, Rutgeerts score>1 showed the highest odds ratio for disease progression (OR 9.02, 95%CI 3.20-25.46, p<0.001).

Rutgeerts score, SES-CD, and MM-SES-CD demonstrated similar predictive accuracy for postoperative disease progression. However, the Rutgeerts score>1 had the strongest predictive value, supporting its continued use while also suggesting that SES-CD and MM-SES-CD can serve as viable alternatives for monitoring postoperative recurrence.