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Comparison of The Toronto IBD Global Endoscopic Reporting (TIGER) score, Mayo endoscopic score (MES), and ulcerative colitis endoscopic index of severity (UCEIS) in predicting the need for ileal pouch–anal anastomosis in patients with ulcerative colitis

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Abstract

Background

Total proctocolectomy (TPC) with ileal pouch–anal anastomosis (IPAA) has been accepted as a radical surgery for refractory ulcerative colitis (UC). We aimed to assess the predictive value of several novel and widely used endoscopic core systems, The Toronto IBD Global Endoscopic Reporting (TIGER) score, Mayo endoscopic score (MES), and ulcerative colitis endoscopic index of severity (UCEIS) in guiding the need for IPAA.

Methods

Data on patients with UC from June 1986 and June 2022 at our institute were collected. The endoscopic evaluation was recorded according to the first colonoscopy after hospitalization. Primary outcome was the need for IPAA during admission and follow-up.

Results

A total of 313 patients with a median follow-up time and a median TIGER score of 12.0 years (interquartile range (IQR): 6.0–17.0) and 212.0 (IQR: 7.0–327.0) were enrolled. IPAA was conducted in 110 (35.1%) patients, which significantly improved the long-term quality of life. TIGER score had the biggest area under the receiver-operating characteristic curve of 0.810 with a sensitivity of 75.0% and specificity of 87.1% at the cut-off value of 315 (p < 0.001). TIGER score ≥ 315 was an independent risk factor with the highest odds ratio for the need for IPAA and associated with the shortest IPAA-free survival time compared with UCEIS and MES.

Conclusion

TIGER score was superior to UCEIS and MES in predicting the need for IPAA. For colorectal surgeons, three or more segments with moderate-to-severe endoscopic activity should be considered as a threshold value for decision-making for IPAA.

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Data availability

The data supporting the conclusions of this article will be made available by the authors, without undue reservation.

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Funding

This work was supported by the National Natural Science Foundation of China (No. 82000481, 82270549 and 82000494), the Shanghai Sailing Program (No. 20YF1429400), and the Qingfeng Scientific Research Fund of the China Crohn’s & Colitis Foundation (CCCF) (No. CCCF-QF-2022C14-21).

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Author notes

  1. Weimin Xu, Fangyuan Liu, and Zhebin Hua contributed equally to this work.

Authors and Affiliations

  1. Department of Colorectal Surgery, School of Medicine, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, 200092, China

    Weimin Xu, Fangyuan Liu, Zhebin Hua, Long Cui & Peng Du

  2. Department of Gastroenterology, School of Medicine, Rui Jin Hospital, Affiliated to Shanghai Jiao Tong University, 197 Rui Jin Er Road, Shanghai, 200025, China

    Yubei Gu

  3. Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 510655, Guangzhou, China

    Lei Lian

  4. Department of Colorectal and Anal Surgery, Hubei Key Laboratory of Intestinal and Colorectal Diseases, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China

    Zhao Ding

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  1. Weimin Xu
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Contributions

Peng Du and Yubei Gu conceived the study. Weimin Xu analyzed the data and wrote the manuscript. Fangyuan Liu and Zhebin Hua assisted some analysis. Lei Lian, Long Cui, and Zhao Ding reviewed and revised the manuscript. All authors approved the final version.

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Correspondence to Yubei Gu or Peng Du.

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384_2023_4347_MOESM1_ESM.docx

Supplementary file1 Supplementary Fig. 1 The improvement of the long-term QOL in patients with UC after IPAA. Preoperative and postoperative (A) current quality of life, (B) current quality of health, (C) current energy level and (D) ultimate CGQL scores were compared.Supplementary Fig. 2 Receiver-operating characteristic curves of UCEIS in predicting the need for IPAA. (A-D) UCEIS had the biggest AUC of 0.720 with a sensitivity of 63.2% and specificity of 80.9% at the cut-off value of 6.Supplementary Fig. 3 Receiver-operating characteristic curves of MES in predicting the need for IPAA. (A-B) MES of 2 had the best predictive value for IPAA with an AUC of 0.656, sensitivity of 49.4% and specificity of 81.8%. (DOCX 861 KB)

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Xu, W., Liu, F., Hua, Z. et al. Comparison of The Toronto IBD Global Endoscopic Reporting (TIGER) score, Mayo endoscopic score (MES), and ulcerative colitis endoscopic index of severity (UCEIS) in predicting the need for ileal pouch–anal anastomosis in patients with ulcerative colitis. Int J Colorectal Dis 38, 53 (2023). https://doi.org/10.1007/s00384-023-04347-3

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