The Utility of Capsule Endoscopy in Crohn’s Disease

The advent of capsule endoscopy (CE) has added greatly to the diagnostic armamentarium of the gastroenterologist. In particular, the diagnosis and management of Crohn’s disease (CD), which affects the small bowel in the majority of cases, has been revolutionized by this technology. CE allows for the visualization of the entire small bowel aiding in the diagnosis, staging, and monitoring of CD. Although there is no pathognomonic finding that defines CD on CE, validated diagnostic scores have emerged to create uniformity in describing and interpreting CE findings. The sensitivity and negative predictive value of CE for the diagnosis of CD have been shown to be superior to that of other techniques commonly used to assess the small bowel. In patients with established disease, CE is emerging as a validated tool for disease monitoring, assessment for postoperative recurrence, and evaluation of patients with indeterminate colitis. Findings on CE may have significant therapeutic implications as the treatment paradigm in CD shifts toward achieving mucosal healing and deep remission. In terms of safety, the emergence of a new generation of patency capsules has decreased the risk of retention in high-risk patients. Due to its favorable performance characteristics, ability to provide clinically relevant data, and safety profile, CE will remain an integral diagnostic tool in patients with CD.