Redondo-Cerezo Eduardo
Eduardo Redondo-Cerezo, Endoscopy Unit, Gastroenterology and Hepatology Department, The University Hospital Virgen de las Nieves, Granada 18014, Spain.
World J Gastrointest Endosc. 2010 May 16;2(5):179-85. doi: 10.4253/wjge.v2.i5.179.
Capsule endoscopy (CE) offers state-of-the-art imaging of the small bowel. In Crohn's disease its clinical role is still uncertain. This report analyses the usefulness of CE in patients with suspected Cronh's disease, in patients with established Crohn's disease (when assessing severity, occult gastrointestinal bleeding and/or as a guide to therapy), in patients with inflammatory bowel disease unclassified (IBDU), and in individuals with ulcerative colitis. The first item in this group is the most important although there is no strong evidence to establish the position of CE in the diagnostic workup. In patients with established Crohn's disease, recently developed activity scores are promising tools for an accurate assessment of severity. As a guide to therapy, CE should be focused on patients with unexplained symptoms when other investigations are inconclusive. In postoperative Crohn's Disease, international consensus recommended considering CE only if ileocolonoscopy is contraindicated or unsuccessful. In the case of IBDU, studies have shown a significant proportion of patients reclassified with Crohn's disease. In this setting, CE could have a role determining small bowel involvement. The role of CE in ulcerative colitis is limited. Some authors advocate CE before colectomy for refractory cases in order to exclude Crohn's disease. In summary, CE offers a new horizon in inflammatory bowel disease, and a better knowledge of mucosal abnormalities that could offer a paradigm shift: changing from symptom-based disease activity estimation to direct mucosal healing monitoring. Nevertheless, randomized controlled studies are still needed to provide stronger evidence in this setting.
胶囊内镜（CE）可提供小肠的先进成像。在克罗恩病中，其临床作用仍不明确。本报告分析了CE在疑似克罗恩病患者、确诊克罗恩病患者（评估严重程度、隐匿性胃肠道出血和/或作为治疗指导时）、未分类的炎症性肠病（IBDU）患者以及溃疡性结肠炎患者中的应用价值。尽管没有强有力的证据确定CE在诊断检查中的地位，但该组中的第一项是最重要的。在确诊的克罗恩病患者中，最近开发的活动评分是准确评估严重程度的有前景的工具。作为治疗指导，当其他检查无定论时，CE应关注有不明症状的患者。在克罗恩病术后，国际共识建议仅在回结肠镜检查禁忌或不成功时才考虑使用CE。在IBDU的情况下，研究表明有相当比例的患者被重新分类为克罗恩病。在这种情况下，CE可能在确定小肠受累方面发挥作用。CE在溃疡性结肠炎中的作用有限。一些作者主张在难治性病例行结肠切除术前进行CE，以排除克罗恩病。总之，CE为炎症性肠病提供了新的视野，更好地了解黏膜异常可能带来范式转变：从基于症状的疾病活动评估转变为直接监测黏膜愈合。然而，仍需要随机对照研究来在这种情况下提供更有力的证据。
