Capsule endoscopy in Crohn's disease

Capsule endoscopy (CE) represents a significant advance in the investigation of small bowel diseases. Two-thirds of Crohn's disease (CD) patients have small bowel involvement at diagnosis. Study of small intestine mucosa by CE may have a strong impact on CD management in a near future. CE may be superior to small bowel cross-sectional imaging for detection of mucosal lesions consistent with CD and a normal CE has a high negative predictive value for active small bowel CD. A GI imaging study should generally precede CE to rule out complications such as fistulas and strictures. In established CD, CE may be useful in patients with unexplained symptoms when other investigations are inconclusive, if this will alter management. The low specificity of CE is its main drawback. Furthermore, there are no validated CD diagnosis criteria for CE and no severity indexes have been independently validated. The role of CE in evaluating mucosal healing and postoperative recurrence will require additional investigation.