{
  "abstract": "Introduction Small bowel capsule endoscopy (SBCE) is well established for small-bowel bleeding and used in selected patients to evaluate possible Crohn’s disease. Chronic diarrhoea is also a common reason for gastroenterology referral, and British Society of Gastroenterology guidance supports SBCE when small-bowel disease is suspected in this context. However, no systematic review has evaluated the diagnostic yield (DY) of SBCE in chronic diarrhoea. We therefore aimed to estimate pooled DY and evaluate clinically relevant subgroups, including patients without suspected organic disease and those investigated for suspected coeliac disease or inflammatory bowel disease.Methods A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. MEDLINE, Embase, PubMed, and the Cochrane Library were searched from 1 November 2000 to 1 November 2025. Studies reporting the DY of SBCE in adults referred for chronic diarrhoea were included. Only English-language publications were considered. Study selection and data extraction were independently performed by two reviewers (I.I.L. and R.N.). Random-effects meta-analysis and meta-regression were used to estimate the pooled DY and to identify overall factors associated with increased DY of SBCE.Results A total of 49 studies comprising 3,977 participants were included. 36/49 studies included only patients who had previously undergone negative upper and lower endoscopy, whereas the remainder did not specify. The pooled DY of SBCE in chronic diarrhoea was 36% (95% CI 30–43%; I 2 =89%). In patients with chronic diarrhoea of unknown origin, the DY was 34% (95% CI 25–44%; I2 =73%). Use of prior small-bowel radiological imaging as a pre-test filter was associated with a higher DY of 47% (95% CI 32–61%; I2 =0%). In suspected IBD, subgroup analysis by faecal calprotectin demonstrated a stepwise increase in DY with higher thresholds: 16% (95% CI 7–32%; I2 =71%) for <50 µg/g, 39% (95% CI 28–50%; I2=90%) for >50 µg/g, and 46% (95% CI 24–69%; I2 =92%) for >100 µg/g. Overall, SBCE led to a change in clinical management in 46% of patients (95% CI 36–57%; I2 = 61%). The pooled completion rate was 94% (95% CI 89–97%) and the pooled retention rate was 1.6% (95% CI 0.9–3.0%; I2 =11%). The pooled patency capsule usage was 32% (95% CI 2.2–91%; I2 =70%).Conclusion The DY of SBCE in patients with chronic diarrhoea is modest overall but improves substantially with appropriate pre-test stratification, particularly using faecal calprotectin. These findings support the use of a calprotectin-guided approach to patient selection and suggest that future studies evaluate the role of panenteric CE as a first-line investigation before colonoscopy in appropriately selected patients.",
  "authors": [
    {
      "affiliations": [
        "Institute of Precision Diagnostics & Translational Medicine, University Hospital of Coventry and Warwickshire, Coventry, United Kingdom",
        "Warwick Medical School, University of Warwick, Coventry, United Kingdom"
      ],
      "name": "Ian Io Lei"
    },
    {
      "affiliations": [
        "Royal Berkshire Hospital, Reading, United Kingdom"
      ],
      "name": "Ian Io Lei"
    },
    {
      "affiliations": [
        "Department of Clinical Research, University of Southern Denmark, Denmark",
        "Department of Surgery, Odense University Hospital, Denmark"
      ],
      "name": "Anastasios Koulaouzidis"
    },
    {
      "affiliations": [
        "Institute of Precision Diagnostics & Translational Medicine, University Hospital of Coventry and Warwickshire, Coventry, United Kingdom",
        "Warwick Medical School, University of Warwick, Coventry, United Kingdom"
      ],
      "name": "Ramesh Arasaradnam"
    }
  ],
  "title": "P44 Diagnostic utility of capsule endoscopy in chronic diarrhoea: a systematic review and meta-analysis",
  "uid": "d3cc572f-4ad8-515a-9740-14930934ab40"
}