ECCO-ESGAR-ESP-IBUS Guideline on Diagnostics and Monitoring of Patients with Inflammatory Bowel Disease: Part 2: IBD scores and general principles and technical aspects - Scorecard - MDSpire

ECCO-ESGAR-ESP-IBUS Guideline on Diagnostics and Monitoring of Patients with Inflammatory Bowel Disease: Part 2: IBD scores and general principles and technical aspects

  • By

  • Henit Yanai

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Roger Feakins

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Mariangela Allocca

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Johan Burisch

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Pierre Ellul

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Marietta Iacucci

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Christian Maaser

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Alessandra Zilli

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Nina Zidar

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Rune Wilkens

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Bram Verstockt

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Stephan Vavricka

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Mathieu Uzzan

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Jaap Stoker

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Martina Scharitzer

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • David Rubin

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Francesca Rosini

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Jordi Rimola

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Patrick van Rheenen

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Paula Borralho Nunes

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Kerri Novak

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Nurulamin M Noor

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Olga Maria Nardone

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Cathy Lu

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Uri Kopylov

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Konstantinos Katsanos

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Isabelle de Kock

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Amelia Kellar

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Konstaninos Karmiris

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Giovanni Maconi

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Frederica Furfaro

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Emma Flanagan

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Ann Driessen

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Mallory Chavannes

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Dominik Bettenworth

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Shomron Ben-Horin

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Gauraang Bhatnagar

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Pamela Baldin

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Torsten Kucharzik

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • Stuart Taylor

  • the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • July 31, 2025

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Clinical Scorecard: Guidelines from ECCO-ESGAR-ESP-IBUS on the Diagnosis and Monitoring of Inflammatory Bowel Disease: Part 2 - Scoring Systems and Fundamental Technical Considerations

At a Glance

CategoryDetail
ConditionInflammatory Bowel Disease (IBD), including Crohn’s Disease (CD) and Ulcerative Colitis (UC)
Key MechanismsAssessment of disease activity through clinical indices, endoscopic scoring, intestinal ultrasound (IUS), and magnetic resonance enterography (MRE)
Target PopulationPatients diagnosed with Crohn’s Disease or Ulcerative Colitis
Care SettingSpecialized gastroenterology clinics and centers with access to endoscopy, imaging, and ultrasound

Key Highlights

  • Use of validated clinical indices and endoscopic scoring systems is recommended to assess disease activity and guide treatment decisions in IBD.
  • Intestinal ultrasound (IUS) and magnetic resonance enterography (MRE) are reliable imaging modalities for detecting disease activity and monitoring response to therapy.
  • Multiple scoring systems exist for UC and CD, each with specific strengths and limitations; no single ideal clinical index exists.

Guideline-Based Recommendations

Diagnosis

  • Employ clinical indices at every patient visit to assess IBD activity.
  • Use endoscopy as the reference standard for assessing disease activity.
  • Apply validated endoscopic scoring systems such as MES, UCEIS, UCCIS for UC and CDEIS, SES-CD for CD.
  • Utilize IUS parameters including bowel-wall thickness and vascularization to detect inflammatory activity.
  • Incorporate MRE scoring systems like MaRIA for CD to evaluate intestinal and mesenteric changes.

Management

  • Aim for remission of disease activity as a therapeutic goal.
  • Use endoscopic scores to guide treatment decisions and assess response to therapy.
  • Consider histological outcomes as emerging therapeutic targets, especially in UC.
  • Apply pouchitis disease activity indices for evaluating J pouch in UC patients post-surgery.

Monitoring & Follow-up

  • Regularly monitor clinical disease activity using validated indices.
  • Use endoscopic scoring systems to evaluate treatment efficacy and disease progression.
  • Implement IUS scoring systems (e.g., IBUS-SAS, BUSS, SUS-CD) for non-invasive monitoring.
  • Employ MRE scores to assess disease activity and response in CD patients.
  • Recognize the need for further validation and automation to facilitate routine clinical use of scoring systems.

Risks

  • No ideal clinical index exists; limitations in scoring systems require cautious interpretation.
  • Time-consuming calculation of some scoring systems may limit clinical applicability without automated tools.
  • Limited data on rectal assessment and lack of universally adopted definitions for rectal transmural remission.
  • Heterogeneity in scoring systems (e.g., modified Rutgeerts score) necessitates careful use in postoperative CD.

Patient & Prescribing Data

Patients with Crohn’s Disease and Ulcerative Colitis undergoing diagnostic and monitoring evaluations

Scoring systems assist in predicting endoscopic remission, guiding therapy adjustments, and evaluating treatment efficacy; histological remission is an emerging target particularly in UC.

Clinical Best Practices

  • Use validated clinical and endoscopic indices consistently to assess disease activity.
  • Incorporate imaging modalities such as IUS and MRE alongside endoscopy for comprehensive monitoring.
  • Apply scoring systems that combine assessment of disease severity and extent when available.
  • Consider the prognostic value of modified scoring systems (e.g., MM-SES-CD) for treatment response prediction.
  • Promote training and standardization in scoring system application to enhance reproducibility and precision medicine.

References

Original Source(s)

ECCO-ESGAR-ESP-IBUS Guideline on Diagnostics and Monitoring of Patients with Inflammatory Bowel Disease: Part 2: IBD scores and general principles and technical aspects

  • by Henit Yanai, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Roger Feakins, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Mariangela Allocca, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Johan Burisch, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Pierre Ellul, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Marietta Iacucci, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Christian Maaser, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Alessandra Zilli, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Nina Zidar, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Rune Wilkens, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Bram Verstockt, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Stephan Vavricka, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Mathieu Uzzan, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Jaap Stoker, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Martina Scharitzer, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], David Rubin, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Francesca Rosini, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Jordi Rimola, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Patrick van Rheenen, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Paula Borralho Nunes, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Kerri Novak, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Nurulamin M Noor, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Olga Maria Nardone, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Cathy Lu, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Uri Kopylov, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Konstantinos Katsanos, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Isabelle de Kock, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Amelia Kellar, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Konstaninos Karmiris, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Giovanni Maconi, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Frederica Furfaro, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Emma Flanagan, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Ann Driessen, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Mallory Chavannes, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Dominik Bettenworth, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Shomron Ben-Horin, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Gauraang Bhatnagar, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Pamela Baldin, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Torsten Kucharzik, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO], Stuart Taylor, the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] the European Society of Pathology [ESP] and the International Bowel Ultrasonography Group [IBUS] on behalf of the European Crohn’s and Colitis Organisation [ECCO]

  • July 31, 2025

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