How Much Time Does Ileocecal Valve Cannulation Add to the Colonoscopy Exam and How Successful Are We at Its Performance?

Abstract

Purpose: Numerous studies have confirmed that a major reason cancers are missed during colonoscopy is the erroneous documentation of cecal entry. Cannulation of the ileocecal valve and visualization of the ileum clearly prove that the cecum has at very least been identified. The purpose of this study was to determine success rate and time requirements for ileal cannulation during elective colonoscopy. Methods: The study comprised 102 consecutive patients (60 females 42 males) undergoing elective colonoscopy by one gastroenterologist (AK) from 4/7/06 to 5/16/06. Patients with previous colonic resections were excluded. Diprovan was the major anesthetic agent used in the study. Time to cecal intubation was obtained in all patients with a stop watch. Subsequently ileal cannulation from the cecum was timed with a stop watch with a time cutoff limitation of 5 mins. The method of ileocecal entry (retroflexed or forward) was recorded. Photo documentation of the ileum was obtained in all successful procedures. Results: Cecal cannulation was accomplished in all 102 patients. Average time to cecal intubation was 3min 42 sec. The ileocecal valve was successfully entered in 89 of 102 patients (87% success rate). Average time to ileocecal cannulation was 1min 38sec. Additional average time added to the entire colonoscopy procedure when employing the 5 min cut off time was 2mins 15secs. Ileocecal cannulation was performed via forward entry rather than retroflexion in the cecum in 84 out of 87 patients. All patients were maintained in the left lateral decubitus postion. No complications were encountered during the study. Conclusions: 1. Ileal cannulation can be performed in a high percentage of elective colonoscopy procedures (87% in this study) in a relatively short period of time. 2. Using a 5 minute cutoff time for attempting ileal intubation added 2min 15sec of additional time to the total colonoscopy procedure. 3. Canulation by retroflexion in the cecum was rarely necessary. 4. Ileocecal valve cannulation demonstrates unequivocal total colonoscopy to the cecum and should be attempted in elective procedures.