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World J Gastrointest Endosc. Sep 16, 2018; 10(9): 184-192
Published online Sep 16, 2018. doi: 10.4253/wjge.v10.i9.184
Capsule endoscopy: Current status and role in Crohn’s disease
Loredana Goran, Ana Maria Negreanu, Ana Stemate, Lucian Negreanu
Loredana Goran, Ana Maria Negreanu, Ana Stemate, Lucian Negreanu, Internal Medicine 2-Gastroenterology Department, University Hospital, Carol Davila University, Bucharest 050098, Romania
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lucian Negreanu, MD, PhD, Professor, Internal Medicine 2-Gastroenterology Department, University Hospital, Carol Davila University, 169, Splaiul Independentei Street, Sector 5, Bucharest 050098, Romania. lucian.negreanu@umfcd.ro
Telephone: +40-72-9439249
Received: April 8, 2018
Peer-review started: April 8, 2018
First decision: April 26, 2018
Revised: July 1, 2018
Accepted: August 4, 2018
Article in press: August 5, 2018
Published online: September 16, 2018
Abstract

Capsule endoscopy (CE) has proved to be an important non-invasive tool for diagnosis and monitoring Crohn’s disease patients. It has the advantage of excellent visualization of digestive tract mucosa, a good tolerability and safety in well-selected patients. The risk of retention can be diminished by good selection of patients using imaging techniques and by the use of patency capsule. The aim of a capsule examination is not only an early diagnosis but also a very good stratification of prognosis, thus directing the treatment strategy for either a step up or top-down approach and also permitting the optimization of the treatment depending on the findings. When symptoms and biomarkers point to a change in the disease’s activity we can either adjust the treatment directly as recommended in CALM study or choose in selected patients to visualize the digestive mucosa through a CE and take a decision afterwards. The appearance of the new capsule from Medtronic-the Pillcam Crohn’s might be an important step forward in diagnosis, evaluating disease extent, the severity of the disease, prognosis, management in a treat to target approach, with treatment modifications according to the data from CE examination. Serial examinations in the same patient can be compared and a more objective evaluation of the lesions modification from one exam to another can be performed. We present the latest developments and current status and evidence that in selected patients capsule can be a tool in a treat to target approach.

Keywords: Capsule endoscopy, Crohn’s disease, Treat to target, Optimise, Colon capsule

Core tip: The target in inflammatory bowel disease has changed during the last years from controlling symptoms to achieving mucosal healing as the final goal of treatment. C-reactive protein and fecal calprotectin have proved their efficacy in monitoring and guiding the treatment in Crohn’s disease as shown by the pivotal CALM study. More and more evidence tends to support a role of iterative capsule endoscopy (CE) examinations. Evidence is based on small bowel and pillcam colon 2 capsule examinations. The appearance of the new capsule from Medtronic-Pillcam Crohn’s might be an important step forward in diagnosis, evaluating disease extent, the severity of the disease, prognosis, management in a treat to target approach, with treatment modifications according to the data from CE examination.