Role of capsule endoscopy in inflammatory bowel disease

Table 1 A comparison of 2 capsule endoscopy scoring indices for quantification of mucosal inflammation

Parameter	Lewis score[8]			CECDAI[80]
	Number/quality	Longitudinal extent	Descriptors	Parameter	Descriptors
Villous appearance	Normal/edematous	Short segment/long segment/whole tertile	Single/patchy/diffuse	Inflammation score	None to large ulcer (> 2 cm)
Ulceration	Non/single/few/multiple	Short segment/long segment/whole tertile	< 25%, 25%-50%, > 50%	Extent of disease	No disease to diffuse (3 segments)
Stricture	Non/single/few/multiple	Ulcerated/non-ulcerated	Traversed/non-traversed	Stricture score	None to complete obstruction
Small bowel segmentation	Tertiles (strictures for the entire length of the examination)			Proximal to distal small bowel
Score	< 135: Normal or clinically insignificant inflammation			0 (normal examination)-26 (severe inflammation)
	135-790: Mild inflammation
	790: Moderate to severe.

CECDAI: Capsule endoscopy Crohn’s disease activity score.

Table 2 Key studies evaluating the diagnostic yield of capsule endoscopy for Crohn’s disease

Modality	Ref.	Number of patients	Diagnostic yield of VCE	Diagnostic yield of the compared modality	IY	P value
CTE	Eliakim et al[81]	35	77%	20%	47%	< 0.05
	Hara et al[82]	17	71%	53%	18%	NA
	Voderholzer et al[83]	41	61%	49% (CT enteroclysis)	12%	< 0.04
	Solem et al[84]	40	83%	83%	0	NS
MRE	Albert et al[85]	27	93%	78%	15%	NS
	Crook et al[22]	19	93%	71%	18%	NS
	Jensen et al[20]	93	100%	86%	14%	NS
Ileocolonoscopy	Hara et al[82]	17	71%	65%	6%	NS
	Solem et al[84]	40	83%	74%	9%	NS
	Leighton et al[86]	80	55%	25%	30%	NA

VCE: Videocapsule endoscopy; CTE: Computed tomography enterography; MRE: Magnetic resonance enterography; IY: Incremental yield; NA: Not available; NS: Non significant.

Table 3 Key studies describing the role of videocapsule endoscopy in established Crohn’s disease

Indication	Ref.	n	Inclusion criteria	Diagnostic criteria	Results
Mucosal healing	Efthimyou et al[28]	40	Patients with active CD (CDAI > 150) who responded to anti-inflammatory treatment, VCE was performed before and after treatment	Number of aphthous ulcers/large ulcers/length of involved segment	Only number of large ulcers correlated with response (8.3 ± 1.4 and 5/0.8, 95%CI: 0.8-5.9, P < 0.01)
Postoperative recurrence	Bourreille et al[31]	31	CD with ileocolonic anastomosis	Rutgeerts score ≥ 1	VCE-21/31 (68%), IC-19/31 (61%)
	Pons Beltrán et al[32]	24	CD with ileocolonic anastomosis	Rutgeerts score ≥ 2	VCE-14/22 (55%), IC-6/24 (25%)
Unexplained symptoms	Dubcenco et al[34]	28	Active CD patients	≥ 3 ulcers	VCE-23 (82%), IC-14 50%, barium radiography-9 (32%)
	Dussault et al[35]	25	Active CD patients with unexplained symptoms	Severity graded by number and appearance of ulcers and presence of stenosis	Active SB inflammation: 11/25 (44%)

In 6 patients treated with immunomodulators, biologics or corticosteroids, a significant improvement was demonstrated in all 3 parameters. CD: Crohn’s disease; VCE: Vidoecapsule endoscopy; IC: Ileocolonoscopy; SB: Small bowel.

Table 4 Key studies describing the role of videocapsule endoscopy in unclassified Inflammatory bowel disease pouchitis and ulcerative colitis

	Ref.	Indication	n	Definition of CD	Results n (%)
IBD-U	Mehdizadeh et al[41]	IBDU	6	> 3 ulcerations-diagnostic of CD, 1-2 ulcerations-suggestive of CD	1 (17)
					SB findings
	Maonoury et al[42]	IBDU	30	> 3 ulcerations-diagnostic of CD, 1-2 ulcerations-suggestive of CD	5 (17), CD
	Cohen et al[43]	IBDU	2	NA	1 (50), CD
s/p IPAA	Mow et al[40]	Isolated colitis	6	> 3 ulcerations-diagnostic of CD, 1-2 ulcerations-suggestive of CD	3 (50)-definite CD, 2 (20), possible CD
	Mehdizadeh et al[41]	Persistent symptoms after IPAA	21	> 3 ulcerations-diagnostic of CD, 1-2 ulcerations-suggestive of CD	7 (33%)
					SB findings
	Calabrese et al[47]	Chronic pouchitis after IPAA	15	NA	Gastric or SB lesions, 15 (100)
Ulcerative colitis	Mow et al[40]	Isolated colitis	12	> 3 ulcerations-diagnostic of CD, 1-2 ulcerations-suggestive of CD	3 (25)-definite CD, 3 (25), possible CD
	Mehdizadeh et al[41]	Treatment-resistant UC	22	> 3 ulcerations-diagnostic of CD, 1-2 ulcerations-suggestive of CD	2 (9), SB findings
	Cohen et al[43]	UC	5	NA	4 (80), CD
	Higurashi et al[44]	UC	23	Lewis score	13 (56.5), small bowel lesions
					9 (39), Lewis score > 135

IBDU: Unclassified inflammatory bowel disease; IPAA: Ileoanal pouch anastomosis; CD: Crohn’s disease; UC: Ulcerative colitis; SB: Small bowel.

Table 5 Potential future technological developments in capsule endoscopy relevant to inflammatory bowel disease

Manually manipulated capsule[77]

Electrically propelled capsule[78]

Tissue sampling capabilities (brushing, cytology, fluid aspiration)[87]

Therapeutic capabilities (cautery)[87]

Drug delivery