To evaluate the role of small bowel and pan-enteric capsule endoscopy in treat-to-target monitoring of Crohn’s disease.

We conducted a systematic review and meta-analysis of studies assessing capsule endoscopy for mucosal healing in Crohn’s disease from database inception to November 2025. We searched PubMed, Embase, Google Scholar, and the Cochrane Library to identify studies performing a baseline capsule examination followed by repeat capsule after medical therapy. Two reviewers independently screened titles, abstracts, and full texts. Reference lists were also examined to identify additional eligible studies. Pooled effect estimates and risk of bias assessments were computed using STATA 19.

The search yielded 829 records, of which nine studies met the inclusion criteria, enrolling a total of 348 patients. Among these, 91% (95% CI, 74% 100%) showed positive findings on baseline capsule endoscopy. The weighted mean age was 30.5 years (95% CI, 28.8 32.2 years), and 44% (95% CI, 37% 51%) were male. Small-bowel visualization was complete in 91% (95% CI, 73%100%) of cases, with no reported capsule retention. Capsule endoscopy detected active inflammation at baseline in 89% of patients. A modification of medical therapy occurred in 97% of patients (95% CI, 88% 100%). After a weighted mean of 33.5 weeks, the pooled rate of mucosal healing was 26% (95% CI, 0.16 0.37; I² = 77.40%; p < 0.001). No statistically significant small-study effects were identified by Egger’s test (p ≥ 0.89). 40% of patients demonstrated reduced inflammation scores (95% CI, 0.33–0.48; p < 0.001; I² = 24.35%; p = 0.23). Meanwhile, the proportion of patients without mucosal healing or mucosal improvement was 33% (95% CI, 0.23–0.45; p < 0.001; I² = 76.8%). 

In the cohort of patients with small bowel Crohn’s disease, capsule endoscopy was a safe and accurate tool for disease monitoring. These findings support incorporating Capsule Endoscopy into treat-to-target strategies to guide therapeutic decision-making in Crohn’s disease with small bowel involvement.