Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes 44093, France.
Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes 44093, France,
World J Gastroenterol. 2019 Aug 21;25(31):4534-4554. doi: 10.3748/wjg.v25.i31.4534.
Crohn's disease (CD) can affect the entire gastrointestinal tract. Proximal small bowel (SB) lesions are associated with a significant risk of stricturing disease and multiple abdominal surgeries. The assessment of SB in patients with CD is therefore necessary because it may have a significant impact on prognosis with potential therapeutic implications. Because of the weak correlation that exists between symptoms and endoscopic disease activity, the "treat-to-target" paradigm has been developed, and the associated treatment goal is to achieve and maintain deep remission, encompassing both clinical and endoscopic remission. Small bowel capsule endoscopy (SBCE) allows to visualize the mucosal surface of the entire SB. At that time, there is no recommendation regarding the use of SBCE during follow-up.
To investigate the impact of SBCE in a treat-to-target strategy in patients with CD.
An electronic literature search was conducted in PubMed and Cochrane library using the following search terms: "capsule endoscopy", in combination with "Crohn's disease" and "treat-to-target" or synonyms. Two authors independently reviewed titles and abstracts identified by the search strategy after duplicates were removed. Following the initial screening of abstracts, all articles containing information about SBCE in the context of treat-to-target strategy in patients with CD were included. Full-text articles were retrieved, reference lists were screened manually to identify additional studies.
Forty-seven articles were included in this review. Two indexes are currently used to quantify disease activity using SBCE, and there is good correlation between them. SBCE was shown to be useful for disease reclassification in patients who are suspected of having or who are diagnosed with CD, with a significant incremental diagnostic yield compared to other diagnostic modalities. Nine studies also demonstrated that the mucosal healing can be evaluated by SBCE to monitor the effect of medical treatment in patients with CD. This review also demonstrated that SBCE can detect post-operative recurrence to a similar extent as ileocolonoscopy, and proximal SB lesions that are beyond the reach of the colonoscope in over half of the patients.
SBCE could be incorporated in the treat-to-target algorithm for patients with CD. Randomized controlled trials are required to confirm its usefulness and reliability in this indication.
克罗恩病（CD）可影响整个胃肠道。近端小肠（SB）病变与狭窄性疾病和多次腹部手术的风险显著相关。因此，评估 CD 患者的 SB 情况是必要的，因为它可能对预后产生重大影响，并具有潜在的治疗意义。由于症状与内镜疾病活动之间存在较弱的相关性，因此已经制定了“针对目标的治疗”（T2T）范式，其相关治疗目标是实现和维持深度缓解，包括临床缓解和内镜缓解。小肠胶囊内镜（SBCE）可观察整个 SB 的黏膜表面。当时，尚无关于在随访中使用 SBCE 的建议。
研究 SBCE 在 CD 患者的 T2T 策略中的影响。
在 PubMed 和 Cochrane 图书馆中进行了电子文献检索，使用了以下搜索词：“胶囊内镜”，结合“克罗恩病”和“针对目标的治疗”或同义词。两位作者独立审查了搜索策略排除重复项后确定的标题和摘要。在初步筛选摘要后，将包含有关 SBCE 在 CD 患者 T2T 策略背景下信息的所有文章均包含在内。检索全文文章，并手动筛选参考文献列表以识别其他研究。
本综述共纳入 47 篇文章。目前有两种指数用于通过 SBCE 量化疾病活动度，并且它们之间具有良好的相关性。SBCE 对于怀疑患有或已诊断患有 CD 的患者进行疾病再分类非常有用，与其他诊断方式相比，具有显著的增量诊断收益。九项研究还表明，SBCE 可评估黏膜愈合情况，以监测 CD 患者的药物治疗效果。本综述还表明，SBCE 可以以与回结肠镜检查相似的程度检测术后复发，并且在超过一半的患者中，近端 SB 病变超出了结肠镜的可达范围。
SBCE 可纳入 CD 患者的 T2T 算法中。需要进行随机对照试验来确认其在该适应症中的有用性和可靠性。
