TOPLINE

A meta-analysis of 10 studies showed that chronic opioid use and diabetes were key patient-level factors that undermined the performance of colon capsule endoscopy (CCE). Chronic opioid use was associated with lower odds of both procedure completion and adequate bowel preparation, whereas diabetes was independently linked to poorer bowel preparation.

METHODOLOGY

• Although CCE offers a noninvasive alternative to colonoscopy for detecting colorectal polyps and cancer, its broader adoption has been limited by incomplete examinations, inadequate bowel preparation, and high follow-up endoscopy rates.
• Researchers conducted a systematic review and meta-analysis by searching published English-language literature across multiple databases through February 2026 to identify patient-related factors associated with CCE outcomes.
• A total of 10 studies involving 4374 participants were included, comprising five retrospective and five prospective studies that evaluated CCE systems among adults aged 18 years or older undergoing investigation for any clinical indication. The mean age of the participants ranged from 57.8 to 67.5 years.
• Primary outcomes assessed included CCE completion rates, bowel preparation adequacy, successful CCE, and follow-up endoscopy rates.

TAKEAWAY

• Across all included studies, the pooled rate of CCE completion was 73% (95% CI, 68%-78%). A pooled meta-analysis of four studies showed that chronic opioid use was associated with lower odds of CCE completion in unadjusted analyses (odds ratio [OR], 0.54; 95% CI, 0.40-0.73), and although the association was not significant after multivariable adjustment, the direction of the association remained unchanged.
• The pooled rate of adequate bowel preparation was 72% (95% CI, 60%-81%). A pooled meta-analysis of two studies showed that diabetes was associated with 60% lower odds of adequate bowel preparation (adjusted OR, 0.40; 95% CI, 0.36-0.45).
• A pooled meta-analysis of three studies showed that chronic opioid use was also associated with lower odds of adequate bowel preparation (adjusted OR, 0.49; 95% CI, 0.26-0.96).
• The pooled rate of successful CCE was 64% (95% CI, 44%-80%), whereas the pooled rate of follow-up endoscopy was 61% (95% CI, 56%-67%).

IN PRACTICE

“For CCE services to remain as a diagnostic option, optimization of completion rate and bowel preparation adequacy is essential to reduce follow-up endoscopy rates and preserve cost-effectiveness….Patient selection emerges as the most immediately actionable and clinically effective strategy to achieve this. Identifying patients at high risk of incomplete examinations or inadequate bowel preparation and directing them straight to optical colonoscopy could avoid unnecessary duplicate procedures, reduce patient burden from repeated bowel preparation, and improve overall service efficiency,” the authors of the study wrote.

SOURCE

The study was led by Ian Io Lei, Institute for Precision Diagnostics & Translational Medicine, University Hospitals Coventry and Warwickshire National Health Service Trust, Coventry, England. It was published online in the Journal of Gastroenterology and Hepatology.

LIMITATIONS

The analysis included only 10 studies and relied on study-level rather than individual participant data. Differences in predictor definitions, patient populations, capsule platforms, and bowel preparation protocols contributed to substantial heterogeneity across studies. The restriction to English-language studies may have introduced language bias.

DISCLOSURES

No funding information was provided for the study. One author disclosed serving as a consultant, participating in advisory boards, receiving research support, lecture honoraria, and educational travel support from multiple companies. He also declared being a cofounder and shareholder of one company and a cofounder or director of another.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.