Capsule endoscopy in Crohn’s disease: Are we seeing any better?

Abstract

Crohn's disease (CD) is a complex, immune-mediated disorder that often requires a multi-modality approach for optimal diagnosis and management. While traditional methods include ileocolonoscopy and radiologic modalities, increasingly, capsule endoscopy (CE) has been incorporated into the algorithm for both the diagnosis and monitoring of CD. Multiple studies have examined the utility of this emerging technology in the management of CD, and have compared it to other available modalities. CE offers a noninvasive approach to evaluate areas of the small bowel that are difficult to reach with traditional endoscopy. Furthermore, CE maybe favored in specific sub segments of patients with inflammatory bowel disease (IBD), such as those with IBD unclassified (IBD-U), pediatric patients and patients with CD who have previously undergone surgery.

Practice patterns and clinical significance of use of capsule endoscopy in suspected and established Crohn's disease

“…Therefore, for patients with sCD, CE is used for diagnostic purposes because it distinguishes CD from other diseases such as intestinal TB and clearly delineates the extent and activity of disease. 26 …”

“… 33 Although MH is currently regarded as an important treatment strategy for patients with CD, data regarding the use of CE to evaluate MH as an indicator of treatment efficacy is limited to Western countries. 26 31 …”

Assessment of mucosal healing in inflammatory bowel disease: review

“…The overall rate of capsule retention in patients with suspected CD is reported to be only 2%, 79 but the rate can be as high as 13% in patients with confirmed CD, and a substantial minority of these patients will require surgical resection of the retained device. 80 In patients without capsule retention, the delayed small-bowel transit time in CD results in the VCE not reaching the ileocecal valve before finishing recording in approximately 20% of patients.…”

Utility of video capsule endoscopy for longitudinal monitoring of Crohn’s disease activity in the small bowel: a prospective study

“…6,15 However, there are limited data on the utility of CE for longitudinal disease monitoring in patients with established CD. [16][17][18][19] Given the high patient acceptance rate and the increasing recognition of the need for objective endoscopic evaluation to monitor CD activity, we aimed to assess the correlation between changes in CE scores compared with the Physician Global Assessment (PGA) as well as the validity and responsiveness of serial CE, as compared with ileocolonoscopy, regardless of medical therapy.…”