The diagnostic yield of pan-enteric capsule endoscopy in inflammatory bowel disease: A systematic review and meta-analysis.
Aravind Gokul Tamilarasan, Yvonne Tran, Sudarshan Paramsothy, Rupert Leong
Published in Sep 2022, Journal of gastroenterology and hepatology.
Background and Aim
Capsule endoscopy (CE) is a non-invasive diagnostic modality enabling real time video imaging of the gastrointestinal (GI) mucosa. Pan-enteric capsule en-doscopy (PCE) is now able to thoroughly assess the entire GI tract, including for inflammatory bowel disease (IBD). Our aim was to evaluate the diagnostic accuracy of PCEs in IBD.
We comprehensively searched electronic databases (MEDLINE, SCOPUS,EMBASE, and Cochrane Central Register of Controlled Trials) for studies comparing the diagnostic accuracy of PCE with endoscopic evaluation, intestinal ultrasound or magnetic resonance enterography (MRE). Data were analyzed by calculating forest plots and the use of theI2statistic for heterogeneity.
Fourteen studies were identified, with seven studies evaluating PCE diagnosticyield in Crohn’s disease (CD) and seven studies in ulcerative colitis (UC). In CD, therewas a trend to superiority of PCE over MRE and colonoscopy with a pooled odds ratio(OR) of 1.25 (95% CI, 0.85–1.86%) for the detection of CD. This translates to an increaseddiagnostic yield of 5% and 7% for PCE compared with MRE and colonoscopy, respec-tively. PCEs had a diagnostic sensitivity for the detection of UC of 93.8% (95% CI,87.6–97.0%) and a specificity of 69.8% (95% CI, 38.2–89.6%).
PCEs have a comparable diagnostic yield to colonoscopy and MRE in Crohn’s disease. The major difficulty remains standardization of PCE scoring systems and the lack of transmural assessment. In UC, PCE has an excellent diagnostic sensitivity and positive predictive value, but there are limitations to its use including the lack of his-tologic assessment and poor specificity