Introduction: Endoscopic assessments are essential for therapeutic decision-making among inflammatory bowel disease (IBD) patients. However, IBD endoscopic scoring indices are not a routine part of clinical practice. The lack of standardization among practicing gastroenterologists (GIs) may result in marked variations in disease activity reporting. The aim of this study was to survey gastroenterologists regarding their knowledge of endoscopic disease activity assessments for IBD patients across the spectrum of disease activity. Methods: An online survey was distributed local practicing GIs including questions about indications for ileocolonoscopy, frequency of disease activity documentation, familiarity with the IBD endoscopic indices, and opinions regarding the importance of endoscopy for decision-making. Representative endoscopic images of varying degrees of colitis activity were given and GIs were asked to score them based on disease severity. Demographic information was collected including number of years post-fellowship and IBD patients seen per month. Results: Of the 380 invitations sent, 81 GIs responded (21% response rate). The majority (66%) of GIs were 10+ years post-fellowship and ≈ 60% of GIs saw more than 10 IBD patients/month. Over 25% of GIs felt endoscopy was the most important factor when assessing disease activity in IBD, and 38% felt it was second only to clinical symptoms. Most respondents reported “always” documenting endoscopic severity for IBD patients (73% in Crohn's, 85% in UC), but only 52% of GIs routinely scoped patients during a flare. Approximately 40% of GIs reported that they seldom or never scoped patients to document mucosal healing (Figure 1).Figure 1There was a frequent lack of consensus among respondents when grading severity of disease based on different endoscopic images with agreement ranging from 47-93% across disease activity states. Only 18-34% of respondents were familiar with the different endoscopic scoring systems used for IBD (Figure 2), yet 64% of GIs felt using endoscopic scoring systems in clinical practice was important.Figure 2Conclusion: There was marked variability among GIs when assessing disease activity with the different endoscopic images provided. Few GIs were familiar with the available IBD scoring systems to grade disease activity. Increased education and utilization of IBD scoring systems may improve the uniformity amongst providers when grading disease activity and improve the quality of IBD care.