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
ARTICLE HIGHLIGHTS
Research background

Crohn’s disease (CD) may affect any part of the digestive tract. Proximal small bowel (SB) lesions, especially jejunal lesions, are associated with an increased risk of stricturing disease and abdominal surgeries compared to esophagogastroduodenal or ileocolonic disease. Thus, assessing the SB may have a significant impact on prognosis. The treat-to-target paradigm was developed in 2015 because of the poor correlation that exists between symptoms and endoscopic disease activity in patients with CD. This concept is based on regular and objective assessment of disease activity and subsequent adjustment of treatment, with the final aim of reaching both clinical and endoscopic remission. Until now, the treat-to-target strategy is based on the assessment of mucosal lesions seen by endoscopy into the ileum and the colon and for the SB by trans-sectional imaging techniques.

Research motivation

The small bowel capsule endoscopy (SBCE) has a higher diagnostic yield compared to the imaging techniques such as the magnetic resonance imaging with enterography (MRE) to detect mucosal lesions especially for the proximal part of the SB and might be more accurate in a treat-to-target strategy. SBCE and MRE are probably complementary, as MRE assesses transmural involvement, while SBCE allows a direct visualization of the mucosal surface of the entire SB. However, there is no recommendation regarding the use of SBCE during patient follow-up.

Research objectives

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

Research methods

An electronic search of the literature was conducted using PubMed and Cochrane library focusing on studies regarding SBCE in the tight monitoring of patients with CD. 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.

Research results

Forty-seven articles were included in total. Twenty-two studies demonstrated the usefulness of SBCE on disease reclassification of patients suspected or diagnosed with CD, with a significant incremental diagnostic yield compared to other diagnostic modalities. Nine studies showed that mucosal healing can be evaluated by SBCE to monitor the effect of medical treatment. Seven studies demonstrated that SBCE could detect post-operative recurrence to a similar extent as ileocolonoscopy, and proximal SB lesions beyond the reach of the colonoscope in more than half of the patients.

Research conclusions

This systematic review provided a global overview of the published studies assessing the use of SBCE in the tight monitoring of patients with CD. SBCE might be incorporated in the treat-to-target algorithm and could be useful for refining disease location and prognosis, assessing mucosal healing in patients under treatment, and monitoring patients in the post-operative setting.

Research perspectives

Randomized controlled trials are required to confirm the reliability of SBCE in the treat-to-target algorithm of patients with CD. In addition, the development of pan-enteric video capsule endoscopy should allow to broaden its indications, all the more so as artificial intelligence is expected to help reduce the burden of capsule endoscopists by automatically detecting and classifying lesions.