The why, when and how of small bowel and panenteric capsule endoscopy in Crohn’s disease

Abstract

Small bowel capsule endoscopy (SBCE) is a tool used for Crohn’s disease (CD) diagnosis and monitorization, which aids in appropriate clinical decision-making, especially in the switch of treatment or withdrawal and influencing reclassification of unclassified inflammatory bowel disease. Compared to cross-sectional imaging, namely intestinal ultrasound and magnetic resonance enterography, SBCE has a superior diagnostic yield in proximal small bowel inflammatory activity, which has been associated with greater morbidity. The risk of capsule retention is higher in patients with established CD with suspected stenosis and those with suspected CD with obstructive symptoms, known stenosis or previous small bowel resection. In these situations, SBCE should be administered only after small bowel patency has been evaluated. There is evidence that the pan-enteric capsule (PEC) has a higher diagnostic yield than ileocolonoscopy in detecting terminal ileum mucosal defects. Future research should evaluate the PEC place in CD algorithms as it offers a non-invasive approach, which is especially important in a long-term follow-up, likely diminishing the disease burden.