S3143 Magnetically Guided Capsule Endoscopy Equals Gastroscopy for Clinically Significant Gastric Lesion Detection: A Systematic Review and Meta-Analysis of 3 Randomized Trials

Introduction: Early detection of gastric neoplasia hinges on high-quality visual inspection, yet uptake of conventional esophagogastroduodenoscopy (EGD) is constrained by sedation, cost, and limited endoscopy capacity. Magnetically guided capsule endoscopy (MGCE) offers a non-sedated, office-based alternative that could widen access, but its diagnostic equivalence to EGD remains uncertain. We therefore synthesized all randomized evidence to determine whether second-generation MGCE matches EGD for clinically significant gastric lesion detection and to map lesion-specific concordance. Methods: A systematic search of PubMed, Embase, Scopus, and Cochrane Library identified randomized controlled trials of MGCE vs conventional EGD in managing ulcerative colitis through May 2025. Data were analyzed using RevMan 4.2.1. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using Mantel-Haenszel methods. Random- or fixed-effects models were applied based on heterogeneity (Higgins’ I2). Statistical significance was set at P < 0.05. Risk of bias was assessed using RoB 2.0. Results: Across 3 randomized trials (n = 462 gastric examinations) magnetically controlled capsule/standing-type capsule endoscopy detected gastric lesions as reliably as conventional gastroscopy (RR 1.05; 95% CI 0.96-1.16; I2 = 0). Leave-one-out sensitivity checks held the estimate within 1.02-1.06 and all CIs crossed unity. Lesion-level concordance in the largest trial was 78% (50/64); MGCE missed 11% and gastroscopy 11%. Agreement for polyps reached 94%, while MGCE captured 5 extra superficial erosions and gastroscopy detected more submucosal nodules. Thus, MGCE delivers patient-level yield equivalent to gastroscopy with complementary lesion-specific strengths. Conclusion: Pooled data show MGCE achieves patient-level detection rates indistinguishable from EGD, with robust sensitivity analyses and no heterogeneity. Lesion-level review reveals 78% concordance, MGCE’s advantage for superficial erosions, and EGD’s edge for submucosal nodules—suggesting complementary strengths rather than outright superiority. These results position MGCE as a viable, sedation-free option for gastric surveillance and triage, warranting larger histology-driven trials to confirm long-term clinical impact.