The role of capsule endoscopy in Crohn's disease

Crohn's disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract, characterized by heterogeneous manifestations with significant morbidities. Diagnosing and managing CD remains challenging due to its variable clinical presentation, complexities in assessing disease extent and activity, and lack of a definitive diagnostic marker. Over the last years, there has been a switch towards a treat-to-target approach in the management of inflammatory bowel disease (IBD). Capsule endoscopy (CE) has emerged as a non-invasive, complementary tool for CD diagnosis and monitoring. CE is patient friendly being wireless and enables direct visualization of the entire small bowel in one sitting. CE plays a role in the diagnostic workup of suspected CD and in cases of in IBD unclassified (IBDU). In established CD, CE plays a role in monitoring mucosal healing, a key therapeutic target linked to improved long-term outcomes. CE findings significantly influence treatment strategies, leading to therapy escalation, adjustment, or avoidance of unnecessary surgical interventions. Moreover, CE disease activity assessment by means of the Lewis score is able to predict disease flares, thus having also a prognostic role. In conclusion, the non-invasive nature of CE, combined with its diagnostic, prognostic, and therapeutic implications, establishes it as an essential tool in the comprehensive management of CD across all disease stages. This review provides a comprehensive update on CE's evolving role in optimizing care of patients with CD.