# Second‐generation capsule endoscopy for the detection of colorectal polyps: An updated systematic review and comparative meta‐analysis of prospective studies

## TL;DR

Second-generation capsule endoscopy is a non-invasive, accurate alternative to colonoscopy for detecting colorectal polyps, potentially improving screening adherence.

## Contribution

This study provides an updated meta-analysis of CCE-2's diagnostic accuracy and evaluates its clinical impact using decision curve analysis.

## Key findings

- CCE-2 showed 89% sensitivity and 94% specificity for polyps ≥6 mm, and 91% sensitivity and 98% specificity for ≥10 mm.
- CCE-2 outperformed colonoscopy in FIT-positive patients and showed greater net benefit from a 20% pre-test probability threshold.
- CCE-2 avoids unnecessary colonoscopies but lacks therapeutic capability and evidence for mortality reduction.

## Abstract

Colorectal cancer (CRC) is the third most common cancer worldwide and the second leading cause of cancer‐related death. Colonoscopy (CO) is the gold standard for screening, but its invasive nature and low adherence limit its use. Second‐generation capsule endoscopy (CCE‐2) emerges as a non‐invasive alternative. This study aimed to evaluate the diagnostic accuracy of CCE‐2 in detecting colorectal polyps, using CO as the reference standard.

A systematic review and meta‐analysis of prospective studies in adults undergoing CCE‐2 followed by CO was performed. Searches were conducted in PubMed, EMBASE and Cochrane up to May 2025. Diagnostic accuracy metrics were pooled using a Bayesian bivariate model with construction of HSROC curves. To assess clinical impact, a fictitious cohort of 1000 patients was simulated based on polyp prevalence and submitted to decision curve analysis (DCA).

Twelve studies including 4316 patients were analysed. CCE‐2 demonstrated sensitivity/specificity of 0.89/0.94 for polyps ≥6 mm and 0.91/0.98 for ≥10 mm. In FIT‐positive patients, performance was superior. In the simulated cohort, CCE‐2 showed greater net benefit from a 20% pre‐test probability threshold of a patient to have a polyp of any size, surpassing the universal CO strategy, avoiding unnecessary colonoscopies to make this diagnostic.

CCE‐2 is a non‐invasive, safe and accurate alternative for CRC screening, with potential to increase adherence, particularly in patients with contraindications or refusal of CO. However, the lack of therapeutic capability and absence of evidence regarding mortality reduction limit its role as a first‐line tool. Randomized clinical trials are needed to consolidate its role in personalized screening.