Applicability of colon capsule endoscopy for monitoring ulcerative colitis: a systematic review

Background: As the target of therapy in Ulcerative colitis (UC) has changed from symptomatic relief to mucosal healing, endoscopic visualization is mandatory. Colon capsule endoscopy (CCE) may serve as a less invasive and more tolerable alternative to standard colonoscopy (SC) for the monitoring of UC. Objectives: To evaluate the diagnostic accuracy, adverse events and tolerability for CCE compared to SC. Design: Systematic review. Data Sources: A systematic literature search was conducted in PubMed, Embase and Web of Science. Methods: Search results were imported into Covidence and screened. Included studies underwent risk of bias assessment using Methodological Index for Non-Randomized Studies (MINORS), and relevant data, including completeness of the procedure, type of bowel preparation and adverse events, was extracted. Pooled estimates of diagnostic accuracy were calculated from the studies providing the necessary data. Results: Out of 2804 articles, six studies were eligible for inclusion. Three provided the necessary data to calculate pooled estimates of diagnostic accuracy in recognizing mucosal inflammation: pooled sensitivity of 93%, specificity of 68.8%, positive predictive value of 89.4%, and negative predictive value of 78.6%. The adverse events, such as nausea and abdominal distension, were predominantly related to bowel preparation regimens. Conclusion: CCE has the potential for monitoring UC. However, the specificity and NPV must be improved. Bowel preparation regimens must be optimized to improve patient experience and the effectiveness of CCE. Registration: Prospero ID CRD42023450210.