Terminal Ileal Intubation during Colonoscopy over a Five-Year Period: Was It Useful?

Abstract

Purpose: The value of routine ileoscopy during colonoscopy is unclear, but intubation of the terminal ileum (TI) is considered to be the main method of confirming completeness of colonoscopy. TI intubation rates are variable and intubation is often omitted due to time constraints and the perception of little added diagnostic value. Our aim was to assess the diagnostic yield of TI intubation during colonoscopies at our institution. Methods: A retrospective study was undertaken at our institution. Colonoscopy data over a 5-year period (1st October 2007 to 30th September 2012), were retrieved from the Endoscopy Reporting System database (Unisoft, Enfield, UK). Patients with ileo-caecal resection were excluded. Demographic data, TI pathology (endoscopic and histopathologic), and indications for colonoscopy were analysed. Results: 8,016 colonoscopies were performed with an overall unadjusted caecal intubation rate of 90.3%. The endoscopists were of different grades including gastroenterologists, colorectal surgeons, and a nurse endoscopist; 206 with previous ileo-caecal resection were excluded. Further analysis was performed on 7,810 colonoscopies. Mean age was 61 years with a female preponderance at 52.6%. The TI was intubated in 1,845 (23.5%). Endoscopic TI pathology was identified in 42 patients (2.3%). Histology was available for 31, of which 23 (1.3%) had confirmed histological abnormalities. Diagnoses on ileoscopy included one adenocarcinoma, one carcinoid tumour, one metastatic malignant melanoma and 20 with terminal ileitis, of which, six had histological features of Crohn's disease. The most common indications in those with TI pathology were diarrhoea (15), abdominal pain (8), and rectal bleeding (8). Conclusion: Although overall diagnostic yield was low, TI intubation identified significant pathologies requiring further action, including three malignancies. Routine ileoscopy at colonoscopy is a simple manoeuvre, which, apart from quality assurance can identify important pathology. The most common indication in those with confirmed TI pathology was diarrhoea, therefore ileoscopy may have added diagnostic value in this context.