Utility of Hybrid Endoscopy Combining Small‐Bowel Capsule Endoscopy and Conventional Ileocolonoscopy in Crohn's Disease

ABSTRACT Objectives To evaluate the safety and utility of hybrid endoscopy for whole‐bowel assessment in Crohn's disease (CD) and its role in treatment decision‐making. Methods This single‐center retrospective study included 125 patients with CD in clinical remission (Crohn's Disease Activity Index ≤150) who underwent hybrid endoscopy between February 2021 and September 2023. These patients were compared with 53 contemporaneous patients who underwent small‐bowel capsule endoscopy (SBCE) alone. Endoscopic remission (ER) was defined as Capsule Endoscopy Crohn's Disease Activity Index <3.5 and Simple Endoscopic Score for Crohn's Disease ≤2. Relapse rates were analyzed according to ER achievement and treatment modification using the Kaplan–Meier method. Results Hybrid endoscopy resulted in a shorter small‐bowel transit time (184 min vs. 243 min, p < 0.01) but better bowel cleansing than SBCE alone. Complete small‐bowel visualization was achieved in 88.8% of patients following hybrid endoscopy, and 66 of 125 patients achieved ER. Patients without ER who did not undergo treatment intensification displayed significantly higher relapse rates ( p = 0.028). Hybrid endoscopy was preferred by 82% of patients. Conclusions This novel hybrid endoscopy approach permits a comprehensive assessment of CD activity using currently available technology. Hybrid endoscopy may be helpful in guiding treatment decisions, particularly treatment intensification in patients who have not achieved ER.