Role of capsule endoscopy in inflammatory bowel disease

Abstract

Videocapsule endoscopy (VCE) has revolutionized our ability to visualize the small bowel mucosa. This modality is a valuable tool for the diagnosis of obscure small bowel Crohn’s disease (CD), and can also be used for monitoring of disease activity in patients with established small-bowel CD, detection of complications such as obscure bleeding and neoplasms, evaluation of response to anti-inflammatory treatment and postoperative recurrence following small bowel resection. VCE could also be an important tool in the management of patients with unclassified inflammatory bowel disease, potentially resulting in reclassification of these patients as having CD. Reports on postoperative monitoring and evaluation of patients with ileal pouch-anal anastomosis who have developed pouchitis have recenty been published. Monitoring of colonic inflammatory activity in patients with ulcerative colitis using the recently developed colonic capsule has also been reported. Capsule endoscopy is associated with an excellent safety profile. Although retention risk is increased in patients with small bowel CD, this risk can be significanty decreased by a routine utilization of a dissolvable patency capsule preceding the ingestion of the diagnostic capsule. This paper contains an overview of the current and future clinical applications of capsule endoscopy in inflammatory bowel disease.

Keywords: Small bowel videocapsule endoscopy; Crohn’s disease; Pouchitis; Indeterminate inflammatory bowel disease; Ileal pouch-anal anastomosis; Patency capsule

Core tip: Videocapsule endoscopy has revolutionized our ability to visualize the small bowel mucosa. This modality is a valuable tool for the diagnosis of obscure small bowel Crohn’s disease (CD), and can also be used for monitoring of disease activity, detection of complications, evaluation of therapeutic response and postoperative recurrence in established CD, evaluation of the small bowel in patients with unclassified inflammatory bowel disease and pouchitis. Monitoring of colonic inflammation in patients with ulcerative colitis has also been reported. This manuscript contains an overview of the current and future clinical applications of capsule endoscopy in inflammatory bowel disease.