Capsule endoscopy for treat-to-target monitoring in Crohn's disease: a systematic review and meta-analysis.
Clelia Marmo, Francesca Sofia Puca, Deirdre McNamara et al.
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In 30 seconds
This systematic review and meta-analysis assessed capsule endoscopy for monitoring mucosal activity and guiding treatment in patients with small-bowel or ileocolonic Crohn’s disease. Nine randomized or observational studies included 321 patients. Active disease was found in 76.3% at baseline, prompting treatment modification in 71% overall and 93% of those with active disease. After a weighted mean follow-up of 33.5 weeks, the pooled proportion achieving mucosal healing was 27% (95% CI, 18%-38%); results showed substantial heterogeneity (I 2 = 71%).
Key findings
- Baseline active disease was detected in 76.3% of patients; treatment was modified in 71% overall and 93% of those with active disease.
- Mucosal healing followed targeted therapy in a pooled 27% of patients (95% CI, 18%-38%) after a weighted mean follow-up of 33.5 weeks.
- Mucosal response occurred in 43% of patients, while 34% showed no response.
- Capsule retention was reported in 1 case.
Why it matters
Capsule endoscopy can assess mucosal activity across the gastrointestinal tract and may identify disease that prompts treatment optimization in treat-to-target care. The pooled healing estimate indicates that healing was achieved in a minority of patients in the included studies, while substantial heterogeneity limits how consistently these results can be applied. Long-term clinical outcomes remain to be clarified.
What to keep in mind
The nine included studies comprised only 321 patients and had substantial heterogeneity (I 2 = 71%). The review also notes that outcome definitions require standardization and that effects on long-term clinical outcomes remain unclear.