Small bowel capsule endoscopy and treat-to-target in Crohn's disease: A systematic review

Table 3 Studies assessing the use of small bowel capsule endoscopy in the monitoring of patients with Crohn’s disease in the post-operative setting

Ref.	Study design	Sample size	Indication for surgery	Risk factors for POR	Post-operative prophylac-tic treatment	Compared modality	Interval between surgery and endosco-pic re-assess-ment	CE findings considered for defining POR	Rate of clinical recurrence, n (%)	Rate of endosco-pic recurren-ce, s (%)
Bourreille et al[49], 2006	Prospective, blinded	32	Resistance to medical treatment (19%) Stenosis (37%) Fistula/abs-cess (44%)	-	None (28%) 5-ASA (22%) CS (3%) IS (9%) Others (44%)	Ileocolono-scopy	Median (IQR): 6 mo (4-7)	Rutgeerts score ≥ i,1	-	Colonosco-py: 19/311 (61%) Se 90%, Sp 100% WCE: 21/31 (68%) Se 76%, Sp 91% SB lesions up to 72%
Biancone et al[50], 2007	Prospective, blinded	22	Resistance to medical treatment (9%) Stenosis (64%) Fistula/abs-cess (14%) Other (13%)	Smoking (32%) Penetrating phenotype (23%)	Mesalamine (100%)	Ileocolono-scopy (gold standard), SICUS	1 year	Ulcers, strictures, or stenosis in the neoterminal ileum and/or anastomosis	0 (0%)	Ileocolonosc-opy: 16/172 (94%) SICUS: 17/172 (1 FP) (100%) WCE: 16/172 (94%) Se 93%, Sp 67%
Pons Beltrán et al[51], 2007	Prospective, blinded	24	Resistance to medical treatment (21%) Stenosis (63%) Other (16%)	Smoking (50%) Penetrating phenotype (38%)	None (100%)	Ileocolono-scopy	Median (range): 254 d (118-439)	Rutgeerts score ≥ i,2	0 (0%)	Ileocolonos-copy: 6/24 (25%) WCE: 15/24 (63%) Jejunal lesions (54%)
Kono et al[52], 2014	Prospective, blinded	19	-	Smoking (11%) Penetrating phenotype (58%) Prior resection (68%)	5-ASA (39%) Anti-TNF (61%)	Ileocolono-scopy at 6-8 mo	mean ± SD: 17.3 ± 5.6 d then 216.9 ± 23.6 d	Lewis score ≥ 135, n (%) and Mean (range)	0 (0%)	Week 2-3: 14/183 (78%) 428.3 (8-4264) 6-8 mo: 9/134 (69%) vs 3/6 (50%) at colonoscopy 196.1 (8-450) 5/13 (38%) with LS higher by ≥ 100 than shortly after surgery
Hausmann et al[53], 20175	Prospective, blinded	22	-	Penetrating phenotype (18%) Prior resection (50%)	None (76%) Azathiopri-ne (6%) Adalimum-ab (18%)	Ileocolono-scopy at 4-8 mo	Mean (range): 57.5 (34 – 83) d then 220 (159 – 322) d	Modified Rutgeerts score ≥ i,2	-	Week 4-8: 3/166 (19%) 4-8 mo: 7 6/12 (50%) vs 5/15 (33%) at colonoscopy
Han et al[54], 2018	Retrospec-tive, blinded	83	Resistance to medical treatment (24.3%) Stenosis (75.7%)	None (100%)	None (100%) before date 1 After date 1 if POR: None (53.1%) Azathiopri-ne (21.6%) Infliximab (25.3%)	Group 1 (37/83): ileocolono-scopy + CE (date 1) then repeat colonoscopy (date 2) Group 2 (46/83): ileocolono-scopy (date 1 and 2)	Date 1: 3-7 mo; after surgery Date 2: 1 year after date 1	Rutgeerts score ≥ i,2 in the terminal ileum or > 5 aphthous lesions in proximal SB or ulcers in proximal SB	Group 1: 1/37 (2.7%) Group 2: 10/46 (21.7%) P = 0.019	Date 1: Group 1: 13/37 (35.1%) at IC vs 24/37 (64.9%) at CE Group 2: 15/46 (32.6%) at IC (P = 0.809) Date 2: Group 1: 8/37 (21.6%) Group 2: 20/46 (43.5%) (P = 0.036)
Kusaka et al[55], 2018	Prospective	25	-	Smoking (22%) Penetrating phenotype (7%) Prior resection (48%)	5-ASA (96%) Elemental diet (30%) IS (19%) Anti-TNF (59%)8	-	< 3 mo	Lewis score ≥ 135	5/25 (20%)	21/25 (84%) mean ± SD: 751.3 ± 984.0 Clinical recurrence rate significantly higher in the group with highest third tertile score (distal SB)

¹The neoterminal ileum was reached and explored by ileocolonoscopy in 31 patients;

²WCE was not performed because of luminal narrowing or stenosis in 5 patients, thus 17 of the 22 patients had all 3 techniques performed;

³In one patient CE did not reach beyond the middle segment of the ileum during the 8 h of recording;

⁴The follow-up CE at 6-8 mo; after surgery was possible in 13 of the 18 patients;

⁵Study assessing the use of pan-intestinal capsule endoscopy (PICE);

⁶Seventeen of the 22 patients (77%) underwent CE at 4-8 wk. Another CE could not be analyzed due to an insufficient large bowel preparation;

⁷Of 17 patients included in the study at follow-up, 14 (82%) underwent CE, and in two cases, analysis of CE videos was hampered by a technical defect and an insufficient large bowel preparation, and 15 (88%) underwent ileocolonoscopy;

⁸Patients could have more than one treatment. ASA: Aminosalicylic acid; CE: Capsule endoscopy; CS: Corticosteroids; FP: False positive; IC: Ileocolonoscopy; IQR: Interquartile range; IS: Immunosuppressant; POR: Post-operative recurrence; SB: Small bowel; Se: Sensitivity; SICUS: Small intestine contrast ultrasonography; Sp: Specificity.