Small bowel capsule endoscopy for management of Crohn's disease: Where do we stand?

Abstract

During the pioneering phase of the use of video capsule endoscopy (VCE), the diagnosis and even the suspicion of Crohn’s disease was considered as an absolute contraindication to the performance of the procedure, because of the risk of capsule retention proximal to a stenosis. In subsequent years, the view has changed, and known or suspected Crohn’s disease is now the second most common indication for VCE, accounting for about 10–15% of the capsule procedures performed. However, Crohn’s disease is diagnosed on the basis of the combination of endoscopic, histological, radiological and biochemical investigations, and therefore, the value of VCE in this setting must be evaluated in the context of the different available techniques. To help establishing the role of VCE and other diagnostic techniques in the management of inflammatory bowel disease, the European Crohn’s and Colitis Organisation (ECCO) and the Organisation Mondiale d’Endoscopie Digestive (OMED) jointly organized a consensus meeting in Brussels in December 2008, which led to the publication of clinical practice guidelines [1]. The reasons why VCE is attractive for the management of Crohn’s disease are that in up to 30% of cases the disease is limited to the small bowel [2], that the technique has limited invasiveness and has the unique possibility of exploring the entire small bowel mucosa. However, VCE also has some drawbacks, such as the inability to take tissue samples, the risk of retention and the lack of a widely accepted classification of small bowel lesions in inflammatory bowel disease. The potential applications of capsule endoscopy in inflammatory bowel disease include the following clinical scenarios: patients with a clinical suspicion of Crohn’s disease, where VCE could help establishing a new diagnosis; patients with known Crohn’s disease, where VCE could help assessing the extent and severity of the disease, and thus assist in making treatment decisions; in previously operated patients, VCE could be used to evaluate the appearance of recurrences; patients with inflammatory bowel disease, unclassified (IBDU), where VCE could help distinguishing ulcerative colitis