Endoscopic evaluation of endoscopy allows for the assessment of disease severity and treatment response in both Crohn’s disease and ulcerative colitis. Endoscopic improvement remains a key treatment target and is associated with better outcomes than symptomatic remission alone. As such, endoscopic assessment of bowel damage is a requirement in the best-management of IBD.

To differentiate levels of severity, endoscopic scoring systems have been developed that incorporates key features of inflammation. Validation of these scoring systems have been conducted to various extents but ultimately need to be simple enough to be used widely, especially in the community outside of clinical trials. The ideal scoring system is simple to use but with a wide enough range to detect with sufficient sensitivity any changes of inflammation. They should be reproducible and with little inter- and intra-observer variability. The STRIDE-II guidelines use the Mayo score of 0 to indicate endoscopic healing in ulcerative colitis and SES-CD <3 (or absence of ulcers) in Crohn’s disease. With minimal training, these are simple enough to be incorporated into everyday practice.