The Toronto Ibd Global Endoscopic Reporting (Tiger) Score: A Single, Easy To Use Endoscopic Score For Both Crohn's Disease And Ulcerative Colitis Patients

J Crohns Colitis. 2021 Jul 17;jjab122. doi: 10.1093/ecco-jcc/jjab122. Online ahead of print.

E Zittan 1 2 3 4, A H Steinhart 2, H Aran 1, R Milgrom 2, I M Gralnek 1 3, S Zelber-Sagi 4, M S Silverberg 2


Author information

  • 1The Abraham and Sonia Rochlin IBD Unit, Department of Gastroenterology and Liver Diseases, Emek Medical Center, Afula, Israel.
  • 2Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases; Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada.
  • 3The Rappaport Faculty of Medicine Technion-Israel Institute of Technology, Haifa, Israel.
  • 4School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.


Background and aims: We constructed the Toronto IBD global endoscopic reporting (TIGER) score for inflammatory bowel disease (IBD). The aim of our study was to develop and validate the TIGER score against fecal calprotectin (FC), C-reactive protein (CRP) and IBD Disk.

Methods: A cross-sectional study was performed among 113 adult patients (60 CD and 53 UC). In the development and usability phase, Blinded IBD experts reviewed and graded ileocolonoscopy videos. In the validity phase the TIGER score was compared to: (1) the Simple endoscopic Score for CD (SES-CD) and the Mayo endoscopic score in CD and UC respectively, (2) FC, CRP and (3) IBD Disk.

Results: Inter-observer reliability of the TIGER score per segment between reviewers was excellent: Interclass Correlation Coefficient (ICC)=0.94; [95%CI: 0.92-0.96]. For CD patients, overall agreement per segment between SES-CD and TIGER was 91% [95%CI: 84-95] with kappa coefficient 0.77 [95%CI: 0.63-0.91]. There was a significant correlation between TIGER and CRP (p <.0083), and TIGER and FC (p <.0001). In addition, there was significant correlation between TIGER and IBD Disk (p < .0001). For UC patients, Overall agreement per segment between Mayo endoscopic score and TIGER was 84% [95%CI:74%-90%] and kappa coefficient 0.60 [95%CI: 0.42-0.808]. There was a significant correlation between TIGER and FC (p < .0001). There was a significant correlation between TIGER and IBD Disk (p < .0001).

Conclusion: The TIGER score is a reliable and simple novel endoscopic score that can be used for both CD and UC patients and captures full endoscopic disease burden.



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