Routine Terminal Ileal Intubation at Colonoscopy Increases Diagnostic Yield

Abstract

Colonoscopy is frequently considered complete if adequate views of the cecum are achieved, with intubation of the terminal ileum (TI) reserved for those patients with specific indications. Whether routine TI intubation results in greater recognition of significant ileal pathology is unknown. AIMS. To determine the clinical and prognostic significance of isolated TI ulceration and inflammation in patients with otherwise normal colonoscopy and small bowel imaging. METHODS. A database was compiled retrospectively using data from endoscopy, pathology, and radiology records from a single hospital covering a 3-year period. Patients included had endoscopic evidence of TI ulceration or inflammation, without colonic involvement or radiological evidence of small bowel disease. Patients with an established diagnosis of inflammatory bowel disease (IBD) were excluded. RESULTS. Seventeen patients meeting the inclusion criteria were identified (mean age 44, 11 male). Four were cigarette smokers, while 7 were on regular non-steroidal anti-inflammatory drugs, including aspirin, at the time of colonoscopy. Four patients described a family history of IBD. Diarrhea and/or abdominal pain were the presenting symptoms in 14 patients. Specific medical therapy was instituted in 6 patients, including corticosteroids in 4, and 5-aminosalicylates in 3. Mean follow-up was 12 months (range 2 - 39 months), at the end of which 11 patients were asymptomatic, while 6 continued to experience symptoms. 2 patients ultimately required surgery. CONCLUSION. While isolated TI ulceration represents a benign self-limiting condition in many individuals, a significant number develop chronic symptoms requiring maintenance medications or even surgery. TI intubation should, therefore, become part of routine colonoscopic evaluation to ensure that these patients are recognised.