Rethinking Effectiveness: Reinvestigation Rates as an Indicator of Colon Capsule Endoscopy – A Systematic Review and Meta-Analysis

Aims To evaluate the reinvestigation rate following colon capsule endoscopy (CCE) and identify the key factors influencing this outcome.

Methods A systematic review and meta-analysis were conducted following PRISMA guidelines. Electronic databases, including Medline, Embase, and PubMed, were searched for studies reporting reinvestigation rates after CCE, including subsequent endoscopic procedures and radiological imaging. A random-effects model was used for meta-analysis and meta-regression to identify key contributing factors.

Results A total of 2,850 participants from 19 studies were included in the analysis. Compared to key performance indicators (KPIs) for reinvestigation rates in colonoscopy (0.10-0.15) and CT colonography (0.25), the pooled reinvestigation rate for CCE was 0.42 (95% CI: 0.34–0.50), appearing notably high. Meta-regression analysis identified complete transit rates and adequate bowel cleansing quality as significantly inversely associated with reinvestigation rates. Additionally, the CCE2 capsule showed a higher reinvestigation risk compared to CCE1, likely reflecting its improved diagnostic accuracy. While CCE indications were associated with lower reinvestigation rates, subgroup analysis did not demonstrate statistical significance, primarily due to high heterogeneity across studies [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19].

Conclusions This study highlights a significant reinvestigation rate for CCE and identifies key contributing factors, emphasising the importance of appropriate patient selection to reduce reinvestigation needs. Future research should focus on improving completion rates, bowel preparation protocols, and refining CCE indications. Addressing these areas will be essential to enhance cost-effectiveness, reduce environmental impact, and improve patient satisfaction, ultimately paving the way for CCE to become a viable and widely adopted diagnostic service in clinical practice.

Conflicts of Interest

Authors do not have any conflict of interest to disclose.

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Publication History

Article published online:
27 March 2025