Capsule endoscopy for treat-to-target monitoring in Crohn's disease: a systematic review and meta-analysis
Clelia Marmo1, Francesca Sofia Puca1, Deirdre McNamara2
1Centro Malattie dell'Apparato Digerente (CEMAD) Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Gastrointestinal Endoscopy
|June 25, 2026
Summary
Capsule endoscopy aids in Crohn's disease management by assessing mucosal healing. This review found it helps optimize treatment, though further studies are needed for long-term outcomes.
Area of Science:
- Gastroenterology
- Inflammatory Bowel Disease
- Diagnostic Imaging
Background:
- Mucosal healing is a key goal in Crohn's disease (CD) management.
- Capsule endoscopy (CE), including small-bowel (SBCE) and pan-enteric (PCE), offers comprehensive mucosal visualization.
- CE supports treatment optimization within treat-to-target strategies.
Purpose of the Study:
- To evaluate the role of SBCE and PCE in treat-to-target strategies for CD.
- To assess the impact of CE on achieving mucosal healing in patients with small-bowel or ileocolonic CD.
Main Methods:
- Systematic review and meta-analysis of randomized clinical trials and observational studies.
- Searched major databases (PubMed, CENTRAL, ClinicalTrials.gov, Google Scholar) up to November 2025.
- Pooled proportion of mucosal healing as the primary outcome using random-effects models.
Main Results:
- Nine studies with 321 patients were included.
- Active disease detected in 76.3%, leading to treatment modification in 71%.
- Pooled mucosal healing rate was 27% (18-38%), with significant heterogeneity (I²=71%).
Conclusions:
- Capsule endoscopy provides a thorough assessment of gastrointestinal mucosal activity.
- It facilitates proactive and personalized treatment adjustments in CD.
- Further research is required to standardize outcomes and confirm long-term clinical benefits.
Related Concept Videos
01:28Endoscopic Procedures III: Video Capsule Endoscopy
Capsule endoscopy, or wireless or video capsule endoscopy, is a diagnostic procedure for examining the entire gastrointestinal tract. Patients swallow a capsule about the size of a vitamin tablet. The capsule is equipped with a transmitter, a battery, an LED light source, and a color video camera to capture images throughout the gastrointestinal tract. This procedure is particularly useful for diagnosing conditions such as Crohn's disease, ulcerative colitis, tumors, polyps, ulcers, unexplained...
01:24Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF
Tumor Necrosis Factor (TNF), a proinflammatory cytokine, contributes significantly to the inflammation seen in Crohn's disease. It exists as soluble TNF and membrane-bound TNF, with actions mediated through TNF receptors (TNFR). TNFR activation leads to the release of proinflammatory cytokines, T-cell activation, collagen production, and leukocyte migration, all contributing to inflammation in Crohn's disease. Anti-TNF monoclonal antibodies, namely infliximab (Remicade), adalimumab (Humira),...
01:29Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel Disease...
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2 (COX-2),...
01:29Drugs for Treatment of Ulcerative Colitis in IBD
Ulcerative colitis is a chronic inflammatory condition primarily affecting the colon and rectum. The primary drugs used in the treatment of ulcerative colitis are aminosalicylates. They exhibit anti-inflammatory and immunosuppressive properties. They modulate inflammatory mediators and inhibit the activity of nuclear factor κB (NF-κB). Aminosalicylates also reduce inflammation by inhibiting prostaglandin and leukotriene production and decreasing neutrophil chemotaxis and superoxide generation.
01:29Inflammatory Bowel Disease IV: Pharmacological Management
Upon diagnosis, managing Inflammatory Bowel Disease (IBD) involves addressing several crucial aspects. The primary goals include resting the bowel, correcting malnutrition, and providing symptomatic relief. Resting the bowel may consist of medications to reduce inflammation and promote healing. Correcting malnutrition is essential, often requiring dietary adjustments and nutritional supplements. Symptomatic relief aims to ease pain, diarrhea, and other discomforts in IBD.
Pharmacologic...
Pharmacologic...