Magnetically Controlled Capsule Endoscopy for Esophageal Varices: Systematic Review and Meta-Analysis

Background: Magnetically controlled capsule endoscopy (MCCE) has shown promise in upper gastrointestinal evaluation and is a potentially less invasive alternative to esophagogastroduodenoscopy (EGD). We performed a systematic review and meta-analysis aiming to measure its diagnostic performance compared to EGD for esophageal varices. Methods: Our protocol was registered on PROSPERO (CRD420251081967). A systematic search of multiple databases was conducted through July 2025 for studies assessing the diagnostic performance of MCCE compared to EGD for EV. The primary outcomes were sensitivity and specificity. Secondary outcomes included the area under the curve (AUC), likelihood ratios, diagnostic odds ratio, and safety. Pooled effect estimates were calculated using a random effects model and expressed as proportions with 95% confidence intervals (CI). Heterogeneity was assessed using the I2 statistic. Results: Five prospective studies with 795 patients (68.8% male, mean age of 55.1) were included. The pooled sensitivity and specificity were 87.1% (95% CI: 68.5–95.4) and 95.2% (95% CI: 88.4–98.1), respectively, with an AUC of 0.97. Following subgroup analysis of cirrhotic patients, pooled sensitivity and specificity were 96.0% (95% CI: 93.6–97.5; I2 = 43%) and 95.2% (95% CI: 84.2–98.6; I2 = 88.4%), respectively. Furthermore, MCCE use with detachable strings increased sensitivity to 96% (95% CI: 93.7–97.5; I2 = 0%) and specificity to 96.3% (95% CI: 87.2–99.0; I2 = 76.8%). Only four adverse events occurred across the five studies. Conclusions: Our meta-analysis demonstrated the high sensitivity, specificity, and diagnostic accuracy of MCCE, along with a favorable safety profile. Further large-scale trials are needed to validate our findings.