Effect of magnetically guided capsule endoscopy on gastrointestinal transit time and diagnostic yield: a systematic review and meta-analysis

Background: Capsule endoscopy (CE) is a primary tool for small bowel visualization, but its diagnostic yield can be limited by prolonged transit times and finite battery life. Various interventions, including prokinetics, purgatives, and magnetic steering, are used to optimize CE performance. This systematic review and meta-analysis compare the effectiveness of these strategies in improving transit times and completion rates. Methods: A systematic search of PubMed, Web of Science, and Scopus was conducted for randomized controlled trials and observational studies evaluating magnetic control, prokinetics, or purgatives in adult patients undergoing small bowel CE. Primary outcomes were gastric transit time (GTT), small bowel transit time (SBTT), and completion rate (CR). A random-effects model was used for all meta-analyses. Results: Forty studies involving 3,041 participants were included. For reducing GTT, Among the included studies, erythromycin and magnetic control were each associated with shorter gastric transit times, while lubiprostone and PEG showed beneficial effects on small bowel transit—relative to their respective controls. Metoclopramide and castor oil were most strongly associated with an increased completion rate. Conclusions: No single intervention optimizes all CE parameters. Erythromycin and magnetic control are effective for rapid gastric transit, while lubiprostone and PEG expedite small bowel transit. To maximize the likelihood of a complete examination, metoclopramide is a well-supported option. These findings allow clinicians to select a tailored pre-procedural strategy based on the specific goals of the CE examination.