Systematic Reviews
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2019; 25(31): 4534-4554
Published online Aug 21, 2019. doi: 10.3748/wjg.v25.i31.4534
Small bowel capsule endoscopy and treat-to-target in Crohn's disease: A systematic review
Catherine Le Berre, Caroline Trang-Poisson, Arnaud Bourreille
Catherine Le Berre, Caroline Trang-Poisson, Arnaud Bourreille, Institut des Maladies de l’Appareil Digestif, Nantes University Hospital, Nantes 44093, France
Author contributions: Le Berre C and Bourreille A designed and performed the literature review and carried out the analysis; Le Berre C drafted the initial manuscript; Bourreille A and Trang-Poisson C critically revised the manuscript for important intellectual content; All authors have read and approved the final version to be published.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA Checklist (2009), and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
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/
Corresponding author: Arnaud Bourreille, MD, PhD, Professor, Institut des Maladies de l’Appareil Digestif, Nantes University Hospital, 1 place Alexis Ricordeau, Nantes 44093, France. arnaud.bourreille@chu-nantes.fr
Telephone: +33-2-40083152 Fax: +33-2-40083154
Received: March 26, 2019
Peer-review started: March 26, 2019
First decision: April 11, 2019
Revised: May 28, 2019
Accepted: July 19, 2019
Article in press: July 19, 2019
Published online: August 21, 2019
Abstract
BACKGROUND

Crohn’s disease (CD) can affect the entire gastrointestinal tract. Proximal small bowel (SB) lesions are associated with a significant risk of stricturing disease and multiple abdominal surgeries. The assessment of SB in patients with CD is therefore necessary because it may have a significant impact on prognosis with potential therapeutic implications. Because of the weak correlation that exists between symptoms and endoscopic disease activity, the “treat-to-target” paradigm has been developed, and the associated treatment goal is to achieve and maintain deep remission, encompassing both clinical and endoscopic remission. Small bowel capsule endoscopy (SBCE) allows to visualize the mucosal surface of the entire SB. At that time, there is no recommendation regarding the use of SBCE during follow-up.

AIM

To investigate the impact of SBCE in a treat-to-target strategy in patients with CD.

METHODS

An electronic literature search was conducted in PubMed and Cochrane library using the following search terms: “capsule endoscopy”, in combination with “Crohn’s disease” and “treat-to-target” or synonyms. Two authors independently reviewed titles and abstracts identified by the search strategy after duplicates were removed. Following the initial screening of abstracts, all articles containing information about SBCE in the context of treat-to-target strategy in patients with CD were included. Full-text articles were retrieved, reference lists were screened manually to identify additional studies.

RESULTS

Forty-seven articles were included in this review. Two indexes are currently used to quantify disease activity using SBCE, and there is good correlation between them. SBCE was shown to be useful for disease reclassification in patients who are suspected of having or who are diagnosed with CD, with a significant incremental diagnostic yield compared to other diagnostic modalities. Nine studies also demonstrated that the mucosal healing can be evaluated by SBCE to monitor the effect of medical treatment in patients with CD. This review also demonstrated that SBCE can detect post-operative recurrence to a similar extent as ileocolonoscopy, and proximal SB lesions that are beyond the reach of the colonoscope in over half of the patients.

CONCLUSION

SBCE could be incorporated in the treat-to-target algorithm for patients with CD. Randomized controlled trials are required to confirm its usefulness and reliability in this indication.

Keywords: Wireless capsule endoscopy, Inflammatory bowel disease, Treat-to-target, Monitoring, Mucosal healing, Post-operative recurrence, Prognosis

Core tip: The treatment goal in patients with Crohn’s disease (CD) combines both clinical and endoscopic remission. Assessment of the small bowel (SB) is substantial because it may have a significant impact on prognosis. Small bowel capsule endoscopy (SBCE) allows direct visualization of the entire SB mucosal surface. We conducted a systematic literature review that aimed to provide a global overview of the studies that assessed the use of SBCE in a treat-to-target strategy in patients with CD. SBCE could be useful for refining the disease location, assessing mucosal healing in patients receiving treatment, and monitoring patients in the post-operative setting.