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Artif Intell Gastrointest Endosc. Aug 28, 2021; 2(4): 136-148
Published online Aug 28, 2021. doi: 10.37126/aige.v2.i4.136
Role of capsule endoscopy in inflammatory bowel disease: Anything new?
Edith Pérez de Arce, Rodrigo Quera, Paulina Núñez F, Raúl Araya
Edith Pérez de Arce, Department of Gastroenterology, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile
Rodrigo Quera, Paulina Núñez F, Raúl Araya, Digestive Disease Center, Inflammatory Bowel Disease Program, Clínica Universidad de los Andes, Santiago 7620157, Chile
Paulina Núñez F, Department of Gastroenterology, Hospital San Juan De Dios, Santiago 8350488, Chile
Author contributions: Pérez de Arce E, Quera R, Núñez F P, and Araya R equally contributed to this review with the conception and design of the study, literature review and analysis, drafting and critical revision and editing, and approval of the final version.
Conflict-of-interest statement: The authors declare no conflict of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: Rodrigo Quera, MD, Assistant Professor, Digestive Disease Center, Clínica Universidad de los Andes, 2501 Plaza Avenue, Las Condes, Santiago 7620157, Chile. rquera@clinicauandes.cl
Received: May 1, 2021
Peer-review started: May 1, 2021
First decision: June 18, 2021
Revised: June 21, 2021
Accepted: August 16, 2021
Article in press: August 16, 2021
Published online: August 28, 2021
Processing time: 127 Days and 11.6 Hours
Abstract

Capsule endoscopy (CE) is a recently developed diagnostic method for diseases of the small bowel that is non-invasive, safe, and highly tolerable. Its role in patients with inflammatory bowel disease has been widely validated in suspected and established Crohn’s disease (CD) due to its ability to assess superficial lesions not detected by cross-sectional imaging and proximal lesions of the small bowel not evaluable by ileocolonoscopy. Because CE is a highly sensitive but less specific technique, differential diagnoses that can simulate CD must be considered, and its interpretation should be supported by other clinical and laboratory indicators. The use of validated scoring systems to characterize and estimate lesion severity (Lewis score, Capsule Endoscopy Crohn’s Disease Activity Index), as well as the standardization of the language used to define the lesions (Delphi Consensus), have reduced the interobserver variability in CE reading observed in clinical practice, allowing for the optimization of diagnoses and clinical management strategies. The appearance of the panenteric CE, the incorporation of artificial intelligence, magnetically-guided capsules, and tissue biopsies are elements that contribute to CE being a promising, unique diagnostic tool in digestive tract diseases.

Keywords: Capsule endoscopy; Inflammatory bowel disease; Crohn’s disease; Artificial intelligence; Capsule Endoscopy Crohn’s Disease Activity Index; Lewis score

Core Tip: Capsule endoscopy (CE) is the non-invasive diagnostic method of choice for visualizing the small bowel. Its utility is widely validated in both suspected and established Crohn’s disease (CD) due to its high sensitivity for detecting early lesions and a high negative predictive value. CE enables estimating the activity and extent of disease, establishing prognosis, and evaluating the therapeutic response in patients with CD. New technologies, such as the panenteric CE and the recent incorporation of artificial intelligence to CE image analysis, render CE an attractive, unique diagnostic tool for diseases of the digestive tract in the future.