Effect of Multiple Pharmacological Interventions and Magnetic Control on Capsule Endoscopy Gastrointestinal Transit Time and Diagnostic Yield: A Systematic Review and Meta-Analysis.

Abstract

<h4>Background</h4>Capsule endoscopy (CE) is widely used for non-invasive evaluation of the small bowel; however, its effectiveness may be hindered by slow gastrointestinal transit and limited battery duration. A range of approaches-including pharmacologic agents, bowel-cleansing preparations, and magnetically guided control-has been introduced to improve the efficiency of the examination. This systematic review and meta-analysis compares the impact of these interventions on transit dynamics and examination completion.<h4>Methods</h4>Comprehensive searches of PubMed, Scopus, and Web of Science identified randomized controlled trials and observational studies assessing magnetic guidance, prokinetics, or purgatives in adults undergoing small-bowel capsule endoscopy. Outcomes of interest included gastric transit time (GTT), small bowel transit time (SBTT), and completion rate (CR). All pooled analyses were performed using a random-effects model.<h4>Results</h4>Fifty-three studies comprising 9095 participants met inclusion criteria. Erythromycin and magnetic guidance were consistently associated with faster gastric passage, while lubiprostone and polyethylene glycol (PEG) shortened SBTT compared with control groups. Metoclopramide and castor oil demonstrated the strongest associations with higher completion rates.<h4>Conclusions</h4>Interventions vary in their effects on CE performance, and no single strategy enhances all parameters simultaneously. Erythromycin and magnetic steering are most useful for expediting gastric transit, whereas lubiprostone and PEG are more effective within the small bowel. For improving overall completion, metoclopramide remains a dependable option. These findings support individualized preparation strategies tailored to the specific diagnostic goals of CE.