Diagnostic Accuracy of Colon Capsule Endoscopy: a Meta-Review

Aims Colon capsule endoscopy (CCE) is a non-invasive diagnostic tool for colorectal disease. It has shown promise for detecting colorectal polyps, cancers, and inflammatory bowel disease (IBD). The aim of this meta-review is to synthesize findings from systematic reviews and meta-analyses to evaluate the diagnostic accuracy of CCE for colorectal polyps, cancers, and IBD, and to assess the impact of methodological quality on reported outcomes [1] [2] [3] [4] [5] [6] [7] [8].

Methods A PubMed search was conducted by one of the authors (AK) using terms such as 'colon capsule endoscopy' and 'capsule colonoscopy”. Filters for 'systematic reviews' and 'meta-analyses' were applied. PRISMA guidelines and AMSTAR-2 criteria were used to evaluate methodological quality. High-quality reviews were defined as those fulfilling at least 9 of 16 AMSTAR-2 criteria. Data on sensitivity, specificity, diagnostic odds ratios, and heterogeneity were extracted and analyzed. We acknowledge using artificial intelligence (AI) assistance OpenAI's ChatGPT for data analysis, and organization. AI was used to refine and synthesize data from the included studies, and ensure clarity in findings presentation.

Results Eight studies (n=8) were included, collectively analyzing over 12,000 patients. Six (n=6) high-quality reviews demonstrated strong adherence to PRISMA and AMSTAR-2 guidelines. These provided consistent estimates for polyps≥6 mm, with pooled sensitivity ranging from 85% to 95% and specificity from 87% to 97%. For polyps≥10 mm, pooled sensitivity exceeded 90%, and specificity reached 95%. Diagnostic odds ratios confirmed strong discriminatory power with low heterogeneity (I²<30%). For IBD, high-quality reviews reported a sensitivity of 88% (95% CI: 81%–93%) and specificity of 89% (95% CI: 82%–93%).Two (n=2) lower-quality reviews reported broader ranges for sensitivity (75%–95%) and specificity (80%–94%) for polyps≥6 mm, with higher heterogeneity (I²>50%). For IBD, sensitivity and specificity estimates showed wider variability, with larger confidence intervals due to inconsistent inclusion criteria, incomplete risk-of-bias assessments, and suboptimal handling of heterogeneity. CCE completion rates ranged from 57% to 92%, with bowel preparation adequacy reported in 70% to 92% of cases. High-quality reviews linked superior preparation protocols to improved diagnostic performance, particularly in IBD studies.

Conclusions Second-generation CCE demonstrates high diagnostic accuracy for detecting colorectal polyps, cancers, and mucosal inflammation in IBD, with sensitivity and specificity comparable to conventional colonoscopy. High-quality systematic reviews adhering to PRISMA and AMSTAR-2 criteria provided consistent and reliable metrics.

 

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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