Patient-Level Predictors of Procedural Success in Colon Capsule Endoscopy: A Systematic Review and Meta-Analysis

Colon capsule endoscopy (CCE) is an increasingly used noninvasive alternative to colonoscopy for colonic investigation. However, its widespread adoption is constrained by suboptimal completion rates (CR), inadequate bowel preparation, and a high follow-up endoscopy rate (FER), collectively undermining cost-effectiveness and service efficiency. Evidence on patient-level predictors of these outcomes remains fragmented.

A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, Embase, CENTRAL, and PubMed Central were searched. Patient-level factors associated with completion rate, bowel preparation adequacy, successful CCE, and FER were extracted. Random-effects meta-analyses were performed to pool unadjusted and adjusted odds ratios.

Ten studies comprising 4374 participants met inclusion criteria. The pooled completion rate was 73% (95% CI 68%-78%), and pooled bowel preparation adequacy was 72% (95% CI 60%-81%). Chronic opioid use was consistently associated with reduced performance, demonstrating lower completion rates (unadjusted OR 0.54, 95% CI 0.40-0.73; adjusted OR 0.55, 95% CI 0.28-1.09) and poorer bowel preparation adequacy (adjusted OR 0.49, 95% CI 0.26-0.96). Diabetes was independently associated with inadequate bowel preparation (adjusted OR 0.40, 95% CI 0.36-0.45). Increasing age showed borderline statistical significance but minimal clinical impact. The pooled follow-up endoscopy rate was 61% (95% CI 56%-67%).

CCE performance is strongly influenced by patient-level factors, particularly chronic opioid use and diabetes. Targeted patient selection is the most immediately actionable strategy to improve efficiency, whereas individual participant data meta-analyses are needed to enable robust risk stratification of CCE.