Diagnostic Yield and Clinical Impact of Small-Bowel Capsule Endoscopy in Chronic Diarrhea: A Systematic Review and Meta-Analysis

Aims Small bowel capsule endoscopy (SBCE) is established as a first-line investigation for suspected small bowel bleeding and Crohn’s disease according to current ESGE guidelines. However, its diagnostic utility in patients with chronic diarrhoea remains unclear, and no systematic review has evaluated SBCE diagnostic yield in this population. We therefore aimed to estimate SBCE diagnostic yield (DY) in chronic diarrhoea and evaluate yield across clinically relevant subgroups, including patients without suspected organic disease and those investigated for suspected coeliac disease or suspected inflammatory bowel disease (IBD). 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 diagnostic yield of SBCE in adults referred for chronic diarrhoea were included. Only English-language full-text publications were considered. Two reviewers independently performed study selection and data extraction. Random-effects meta-analysis and meta-regression were used to estimate the pooled DY and to identify factors associated with increased DY of SBCE. Results A total of 49 studies comprising 3,977 participants were included. The pooled DY of SBCE in chronic diarrhoea including all suspected pathologies was 36% (95% CI 30–43%; I²=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 increased DY to 47% (95% CI 32–61%; I²=0%). In suspected IBD, subgroup stratification 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. Meta-regression revealed no significant moderators. Overall, SBCE led to a change in clinical management in 46% of patients (95% CI, 36–57%; I²=61%). Conclusions SBCE demonstrates a moderate DY and is associated with changes in subsequent management in one in two patients with chronic diarrhoea. These findings also support a biomarker-informed, calprotectin-guided approach to patient selection. Future prospective studies should formally evaluate the role of early capsule endoscopy within diagnostic pathways, alongside or following colonoscopic assessment, in appropriately selected patients. Publication History Article published online: 06 June 2026 © 2026. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany