| Sumario: | Background: Colorectal cancer (CRC) incidence is rising globally, intensifying pressure on endoscopy services. Colon capsule endoscopy (CCE) offers a non-invasive alternative. Despite several systematic reviews showing reasonable polyp detection rates, clinical scepticism remains. Objectives: This meta-review and umbrella meta-analysis aim to synthesise evidence on CCE's diagnostic accuracy in polyp and CRC detection, using CT colonography or colonoscopy as the reference standard. Methods: We conducted a systematic search of EMBASE, MEDLINE and PubMed for systematic reviews evaluating the diagnostic accuracy of CCE in detecting polyps and CRC. A qualitative thematic review and synthesis were conducted following PRISMA guidelines. A bivariate generalised linear mixed model with random effects was used for pooled diagnostic accuracy estimates, and meta-regression was performed using restricted maximum likelihood estimation. Results: Nine systematic reviews encompassing 28 unique studies (3472 participants) were included. For polyps of any size, the pooled per-patient sensitivity was 0.79 (95% CI: 0.69–0.86), specificity was 0.77 (95% CI: 0.71–0.82), and the area under the curve (AUC) was 0.81. For polyps ⩾6 mm, sensitivity and specificity were 0.80 and 0.87 (AUC 0.81), and for polyps ⩾10 mm, 0.88 and 0.95 (AUC 0.95), respectively. Second-generation CCE (CCE2) improved diagnostic accuracy across all polyp sizes. For polyps of any size, CCE2 achieved a sensitivity of 0.90, specificity of 0.81 and AUC of 0.82. For polyps ⩾ 6 mm and ⩾10 mm, AUCs were 0.92 and 0.94, respectively. CCE2 showed high sensitivity for detecting any polyp size and polyps ⩾6 mm, with low heterogeneity (p > 0.05, I 2 < 25%). CRC detection sensitivity was 0.96 (95% CI: 0.73–1.00) after excluding cases where the capsule failed to reach the rectum due to battery exhaustion. Conclusion: CCE2 has high diagnostic accuracy for polyps and colorectal cancer detection. While technical challenges persist, CCE2 shows promise as a complementary diagnostic tool to help address the increasing demands for endoscopy services. Plain language summary: Colon capsule endoscopy (CCE) is a camera pill that patients swallow to check the inside of their colon without needing a traditional colonoscopy. Although this method is less invasive, it hasn't been widely adopted, partly because doctors are unsure how accurate it is in spotting problems like polyps (small growths) or bowel cancer. This study reviewed and combined data from nine major research reviews involving 3,472 patients. The goal was to find out how good CCE is at detecting polyps and colorectal cancer (bowel cancer) compared to standard tests like colonoscopy and CT colonography. The results showed that second-generation CCE devices (CCE2) performed well. For larger polyps (over 10 mm), the camera pill correctly identified them in 88% of cases and correctly ruled them out in 95% of cases. When it came to detecting bowel cancer, the accuracy was even higher, around 96%, as long as the capsule finished the test (seen the whole colon) before the battery ran out. The newer version of the capsule (CCE2) was better than older models, especially in detecting both small and large polyps. This suggests that, with current technology, CCE can be a reliable tool for detecting bowel problems early. In summary, CCE2 offers a promising alternative for bowel screening, particularly when regular colonoscopy is delayed or difficult. It could help ease pressure on healthcare services while still delivering accurate results.
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