Clinical Benefit of Capsule Endoscopy in Crohn’s Disease: Impact on Patient Management and Prevalence of Proximal Small Bowel Involvement

Abstract

CE is a safe imaging modality that alters clinical management in patients with established SBCD by adding incremental information not available at ileocolonoscopy and cross-sectional enterography.

Usefulness of panoramic 344°-viewing in Crohn’s disease capsule endoscopy: a proof of concept pilot study with the novel PillCam™ Crohn’s system

“…In established CD patients, the recognition of active small-bowel disease resulted in refined disease staging and targeted treatment escalation, thereby strengthening the emerging role of CE in two-thirds of cases [5][6][7]. These results are consistent with those reported in two longitudinal studies conducted with standard-view CE devices showing an impact on clinical management in 34-52% of established CD patients [6,8].…”

“…A "definite diagnosis of CD" was defined in patients with relevant capsule endoscopy findings for the diagnosis of active CD plus coherent device-assisted enteroscopy with histopathology or cross-sectional imaging during follow-up [3]. A "treatment strategy upgrade" was considered for patients receiving treatment (add on or switch to) steroids, immunomodulators or biologics during follow-up [5,6,8].…”

“…Furthermore, CE has emerged as a key tool for disease staging (i.e. location, extent, severity) and monitoring, facilitating a refined clinical classification and tight control management [5][6][7][8].…”

Endoscopic ultrasonography and small‐bowel endoscopy: Present and future

“…Thanks to the wide implementation of SB patency tests (patency capsule or entero‐MR/CT), in recent studies, the risk of capsule retention has remarkably decreased (up to 2.5% in established Crohn's disease) . In parallel, CE assessment of disease severity and extent in the SB has emerged as a valid diagnostic target for patients with a new diagnosis of Crohn's disease, irrespective of the findings at ileocolonoscopy, and as a reliable tool for longitudinal monitoring in the era of treat‐to‐target strategies . The advent of capsule devices with a prolonged operating time has recently opened the era of pan‐intestinal CE .…”

“…155 In parallel, CE assessment of disease severity and extent in the SB has emerged as a valid diagnostic target for patients with a new diagnosis of Crohn's disease, irrespective of the findings at ileocolonoscopy, 156 and as a reliable tool for longitudinal monitoring in the era of treat-to-target strategies. [157][158][159][160][161][162] The advent of capsule devices with a prolonged operating time has recently opened the era of pan-intestinal CE. 159,162 This all-in-one and on-demand approach has a promising application in IBD 159,[162][163][164][165] where it can supposedly speed up the diagnostic work-up and decrease the need for endoscopic procedures.…”