Going the Extra Inch: Quantifying the Benefits of Terminal Ileal Intubation

Abstract

Aims: Intubation of the terminal ileum during colonoscopy is a technically demanding skill. Successful intubation of the terminal ileum may aid in the diagnosis and staging of gastrointestinal disorders. This may change patient management and improve patient care. We aim to quantify the utility and potential benefit of terminal ileal intubation in routine colonoscopy. Methods: This study was set in the gastroenterology department of a 630 bed university teaching hospital. The “Endoscribe” endoscopy program was used to retrospectively identify all colonoscopies involving intubation of the terminal ileum from July 2000 to November 2003 performed at our institution. These were then matched with histology results and radiological investigations. Results: Terminal ileal intubation was described in 1650 colonoscopies during the study. Terminal ileal disease was identified in 106 (6.43%) patients. Indications for colonoscopy in this group included assessment of known or suspected Crohn's disease (50%), diarrhoea (21.69%) and bleeding per rectum (9.43%). Isolated terminal ileal disease was identified in 31 (1.88%) cases, including 21 patients with isolated terminal ileal Crohn's disease and 8 patients with terminal ileal ulceration. Terminal ileal intubation extended the staging of disease in 75 (4.55%) cases, including 63 patients with Crohn's disease, 2 with indeterminate colitis, 2 with ulcerative colitis and 2 with self-limiting colitis. One patient in this group was subsequently identified as having campylobacter enteritis. One had Peutz Jeghers syndrome and one had portal colopathy. In addition, 26 (1.57%) post-operative cases were identified with terminal ileal or anastomotic inflammation following right hemicolectomy. Twenty two small bowel barium studies were performed on the group with isolated terminal ileal disease, 10 of which did not demonstrate terminal ileal disease. Failure to intubate the terminal ileum would lead to failure to make the diagnosis in 3.54% of otherwise normal colonoscopies and failure to extend the staging of disease in 9.31% of abnormal colonoscopies. Conclusions: Intubation of the terminal ileum is an important investigation in making the diagnosis and quantifying the extent of gastrointestinal disease. Terminal ileal intubation should form part of routine colonoscopic examination.