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Bojórquez et al. Mini-invasive Surg 2023;7:8 https://dx.doi.org/10.20517/2574-1225.2022.65 Page 5 of 7

yield to ileocolonoscopy. In this study, PEC showed better outcomes (83.3% vs. 69.7%) even when only the
[27]
detection rate of terminal ileum lesions was taken into consideration (70% vs. 54%) . Bruining et al.
published a multicenter, prospective study including 158 patients evaluating the overall sensitivity of PEC
versus ileocolonoscopy plus MRE. They concluded that capsule endoscopy sensitivity had a similar
diagnostic yield in the terminal ileum and colon and a better diagnostic yield than MRE for proximal small
[28]
bowel activity (97% vs. 71%) .
Several studies have demonstrated the feasibility of PEC in diagnosing and monitoring CD . Tai et al.
[29]
studied the feasibility, safety and impact on management that PEC had on 93 patients (71 established and 22
with suspected CD), finding that half of the patients had active disease, 20% had proximal small bowel
involvement leading to a change in management, with only a 2.8% capsule retention rate .
[30]

Pediatric patients may benefit from using PEC by diminishing the invasiveness and number of procedures
needed for diagnosis and monitoring the affected segments. Current guidelines recommend a full evaluation
of the gastrointestinal tract at the time of CD diagnosis [31-33] . Oliva et al. evaluated the feasibility of using
PEC to evaluate mucosal response to treatment and guide therapeutic modifications compared to other
testing modalities in a cohort of 48 pediatric patients with established CD. The overall diagnostic yield of
PEC, MRE, and biomarkers were 54%, 37%, and 33%, respectively (P < 0.05) .The Capsule Endoscopy-
[34]
Crohn’s Disease (CE-CD) index and the Eliakim score have been developed to standardize image
interpretation, taking into account the findings of the small and large intestines. The CE-CD was
determined to be reliable in pediatric patients and correlated well with the Pediatric Crohn’s Disease
Activity Index (PCDAI) and the Eliakim score with the Lewis score [35,36] .

PEC may potentially reduce the burden of disease by diminishing the number and invasiveness of
procedures and improving diagnosis in proximal segments when used in non-stricturing CD.

CONCLUSION
In conclusion, small bowel capsule endoscopy (SBCE) has emerged as a valuable tool for both diagnosing
and monitoring Crohn’s disease (CD). With a higher diagnostic yield in proximal small bowel compared to
cross-sectional imaging, SBCE has the potential to lead to a change in management, ultimately reducing the
burden of disease. Additionally, confirmation of small bowel patency through SBCE is essential for patients
with obstructive symptoms, known stenosis, or a history of small bowel resection.

Looking to the future, further research is needed to explore the suitability of the pan-enteric capsule (PEC)
in CD diagnosis and management. The potential for the PEC to provide a non-invasive and comprehensive
approach to a panintestinal disease is an exciting prospect that warrants further investigation. By continuing
to refine and innovate these techniques, it is expected to provide patients with more effective and efficient
care, while minimizing the impact of this complex and challenging disease.

DECLARATIONS
Authors’ contributions
Made substantial contributions to the conception and design of the review: Bojórquez A, Carretero C

Availability of data and materials
Not applicable.