How to use it
Score three descriptors at the most severe area of the examination: vascular pattern (0–2), bleeding (0–3) and erosions and ulcers (0–3). The total runs from 0 to 8. Each descriptor has a fixed definition, shown under each option; read them rather than scoring by feel. Agreement between endoscopists is only moderate (kappa 0.50 in the validation study), so the definitions matter.
The UCEIS was built from flexible sigmoidoscopy videos. It does not describe extent, so record the extent separately.
Reading the result
| UCEIS | Usual label |
|---|---|
| 0–1 | Inactive; meets the STRIDE-II definition of endoscopic healing |
| 2–4 | Mild |
| 5–6 | Moderate |
| 7–8 | Severe |
These bands are widely used in research and practice, but they are a convention: the development and validation papers did not define them. Use the total, and whether it reaches the target of ≤1, for treat-to-target decisions.
STRIDE-II sets endoscopic healing in UC as a Mayo endoscopic subscore of 0 or a UCEIS of 1 or less. A UCEIS of 1 means one descriptor at its first abnormal level and the others normal: patchy obliteration of the vascular pattern, washable mucosal blood, or erosions.
Acute severe colitis
In 89 patients admitted with acute severe UC (Truelove and Witts), a higher UCEIS on admission predicted the need for rescue therapy (Corte 2015):
- UCEIS ≥5: 27 of 54 (50%) needed infliximab or ciclosporin, versus 9 of 33 (27%) with UCEIS ≤4.
- UCEIS 7–8: 11 of 14 needed rescue therapy and 13 of 14 had an adverse outcome (rescue therapy, colectomy or readmission).
- Colectomy during follow-up: 18 of 54 (33%) with UCEIS ≥5, versus 3 of 33 (9%) with UCEIS ≤4.
A UCEIS of 7 or 8 on admission is a reason to plan rescue therapy early. It does not mean colectomy is inevitable. This was a single-centre, retrospective study.
Pitfalls
- Friability isn’t scored. Contact bleeding is not “bleeding” in the UCEIS. Only blood you see before touching the mucosa counts.
- Mucosal versus luminal blood. Spots or streaks that wash away are mucosal (1). Free liquid blood in the lumen is luminal (2 or 3).
- Erosion or ulcer? The cut-off is 5 mm. Larger, fibrin-covered defects are ulcers.
- Document the Mayo endoscopic subscore too. Most trials and many guidelines still report it. Use the Mayo score tool.