Achieving mucosal healing has become a central therapeutic objective in treat-to-target strategies for Crohn's disease (CD). Capsule endoscopy, including small-bowel capsule endoscopy (SBCE) and pan-enteric capsule endoscopy (PCE), enables comprehensive mucosal evaluation and supports treatment optimization. This systematic review and meta-analysis aimed to evaluate the role of SBCE and PCE within treat-to-target strategies in patients with small-bowel or ileocolonic CD. A systematic search of PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and Google Scholar was conducted from inception to November 2025. Randomized clinical trials and observational studies using capsule endoscopy to monitor mucosal activity and guide therapy were included. The primary outcome was the proportion of patients achieving mucosal healing after targeted medical therapy. Pooled proportions were estimated using random-effects models, and heterogeneity was assessed using the I2 statistic. Nine studies comprising 321 patients were included. The weighted mean age was 31.3 years, and 46% of patients were male. Active disease was detected in 76.3% of patients at baseline, leading to treatment modification in 71% overall and in 93% of patients with active disease. After a weighted mean follow-up of 33.5 weeks, the pooled proportion of patients achieving mucosal healing was 27% (95% CI, 18%-38%), with substantial heterogeneity (I2 = 71%). Mucosal response was observed in 43% of patients, whereas 34% showed no response. Capsule retention was observed in 1 case. Capsule endoscopy enables comprehensive assessment of mucosal activity across the GI tract and supports proactive, individualized treatment optimization within treat-to-target strategies. Further prospective studies are needed to standardize outcome definitions and to clarify their impact on long-term clinical outcomes.

High-quality, annotated data sets are fundamental to clinical research and artificial intelligence (AI) model development. Existing endoscopic databanks are predominantly retrospective, image-based, or lacking patient consent and structured prospective clinical annotations, limiting scientific reproducibility and regulatory-compliant AI validation. This study establishes a prospective endoscopy video databank with standardized annotations enabling AI development and clinical outcomes research. Since 2022, we have prospectively enrolled consecutive patients undergoing EGD or colonoscopy at a tertiary center (NCT06822616). Endoscopies were recorded in full (1920 × 1080 resolution, 60 frames per second, 10-bit color depth) and deidentified at acquisition. Trained staff documented timestamped anatomical landmarks, lesion characteristics, optical diagnoses, interventions, and disease scores in structured case report forms during procedures. Pathology results and metadata were linked to all events observed during the endoscopies and corresponding timestamped video frames. Up to March 2026, a total of 8658 patients (mean age, 59.3 years; 52.0% female) were enrolled, contributing 10,831 procedures (7909 colonoscopies and 2922 EGDs) performed by 55 endoscopists. Each colonoscopy and EGD captured up to 747 and 455 structured variables, respectively. Individual polyps (n = 10,057) and biopsies (n = 11,346) were annotated with 49 and 45 variables, respectively. Inflammatory bowel disease-specific documentation comprised up to 188 variables per procedure. Pathologic findings were present in 83.7% of records. This prospective databank provides the infrastructure for endoscopy research requiring traceable data sourcing, whether for clinical outcomes research or AI development and validation. The integration of full-length videos, real-time procedural annotation, and histopathologic correlation addresses critical gaps in optimizing clinical outcomes and AI research.