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Kim DS, Ryu JE, Shin J, Koo HS, Lee S, Cho H, Na J, Huh KC. Diagnostic Value of Ileal Lesions Found during Colonoscopy with Reference to Endoscopic Indications and Findings. J Clin Med 2024; 13:1161. [PMID: 38398473 PMCID: PMC10889396 DOI: 10.3390/jcm13041161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/02/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
The diagnostic value of ileoscopy is not well established, and its routine practice is controversial. We aimed to investigate the diagnostic value of biopsy for macroscopically abnormal lesions in the terminal ileum and to identify the association between endoscopic indications and findings and the presence of significant disease. This retrospective study included 551 patients who underwent biopsy of abnormal lesions in the terminal ileum (TI) during colonoscopy between February 2000 and June 2019. Biopsy results were analyzed in relation to the endoscopic indications and gross findings. Significant disease was defined as a case in which a specific disease was suspected or confirmed by the biopsy results, requiring additional examination or treatment. Among the 551 biopsies from macroscopically abnormal lesions in the TI, 44 (8.0%) had significant diseases. The frequency of significant disease was high in patients with clinically suspected inflammatory bowel disease (IBD) (50.0%), anemia (31.6%), right lower quadrant (RLQ) pain (28.6%), and radiological abnormalities in the TI (27.5%). The frequency of Crohn's disease (CD) was high in patients with clinically suspected IBD. A concurrent abnormality in the ileocecal valve (ICV) (14.3%) and the presence of an ulcer (14.2%), mass, or polyp (25.4%) correlated with a high incidence of significant disease, particularly CD. In cases of suspected IBD, anemia, RLQ pain, and radiologic abnormalities in the TI, there is a high possibility of significant disease. Ulcers, masses, polyps, and concurrent abnormalities in the ICV were also associated with significant disease.
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Affiliation(s)
- Dae Sung Kim
- Division of Gastroenterology, Department of Internal Medicine, Konyang University College of Medicine, Daejeon 35365, Republic of Korea
| | - Ji Eun Ryu
- Healthcare Center, Konyang University Hospital, Daejeon 35365, Republic of Korea
| | - Jieun Shin
- Konyang Medical Data Research Group-KYMERA, Konyang University Hospital, Daejeon 35365, Republic of Korea
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon 35365, Republic of Korea
| | - Hoon Sup Koo
- Division of Gastroenterology, Department of Internal Medicine, Konyang University College of Medicine, Daejeon 35365, Republic of Korea
| | - Sanghyuk Lee
- Division of Gastroenterology, Department of Internal Medicine, Konyang University College of Medicine, Daejeon 35365, Republic of Korea
| | - Hwanhyi Cho
- Division of Gastroenterology, Department of Internal Medicine, Konyang University College of Medicine, Daejeon 35365, Republic of Korea
| | - Jongheon Na
- Division of Gastroenterology, Department of Internal Medicine, Konyang University College of Medicine, Daejeon 35365, Republic of Korea
| | - Kyu Chan Huh
- Division of Gastroenterology, Department of Internal Medicine, Konyang University College of Medicine, Daejeon 35365, Republic of Korea
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CELAYIR MF, KOKSAL HM, TANAL M, ULUDAG M. The necessity of routine terminal ileum intubation during colonoscopy. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2022. [DOI: 10.23736/s0393-3660.20.04447-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Alkhalidi N, Alrubaie A, Rezqallah RE, Kenber M. The Value of Terminal Ileum Intubation During Colonoscopy. JOURNAL OF COLOPROCTOLOGY 2022. [DOI: 10.1055/s-0041-1739298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractIt is uncertain whether terminal ileum intubation should be performed routinely during colonoscopy, as there is uncertainty regarding its diagnostic value. The aim of the present study is to assess the diagnostic yield of terminal ileum intubation during colonoscopy according to indications for colonoscopy. This is a cross-sectional study in which the results of 294 total colonoscopy procedures were reviewed; ileal intubation was performed in 269 (91.49%) patients. The indications for colonoscopy, the results of ileoscopy, and the histopathological results of ileal biopsies were evaluated.A total of 54 (20%) out of 269 patients who had successful intubation into the terminal ileum showed macroscopic abnormalities on the terminal ileum. Biopsies were positive in 4 out of 54 (7.4%); all were of Crohn disease. Two were erosions (9.5%.) and 2 were ulcers (18.8%). The two erosions were presented as abdominal pain, abdominal pain and alternating bowel motion. Those with ulcers were presented with diarrhea and perianal disease.
Conclusions Considering the low diagnostic yield of ileal intubation during colonoscopy, the decision to perform ileoscopy or not during colonoscopy needs to be made on a case-by-case basis. However, routine ileal intubation, brief attempts should be considered despite low diagnostic yield.
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Affiliation(s)
- Nawal Alkhalidi
- Department of Gastroenterology and Hepatology Center Baghdad, Baghdad, Iraq
| | - Abdulhadi Alrubaie
- Department of Surgery, Alkindy College of Medicine/University of Baghdad, University of Baghdad, Baghdad, Iraq
| | - Raed Esttaifan Rezqallah
- Department of Surgery, Alkindy College of Medicine/University of Baghdad, University of Baghdad, Baghdad, Iraq
| | - Maitham Kenber
- Vice President for Scientific Affaires, University of Al-Ameed, Karbala. Professor of Surgery, Departement of Surgery, University of Kufa, Iraq
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Alkhatib AA, Kumar S. Clinical Yield of Ileal Intubation During Screening Colonoscopy. Cureus 2022; 14:e20870. [PMID: 35145777 PMCID: PMC8803374 DOI: 10.7759/cureus.20870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives Ileal intubation during screening colonoscopy can serve as supportive evidence of complete examination. However, most studies conducted in Western countries showed a limited value of ileal inspection in asymptomatic patients undergoing colonoscopy. Therefore, our aim is to determine the clinical yield of routine ileal examination during the performance of screening colonoscopy in a cohort of patients in the Middle East and identify factors associated with successful ileal intubation in this setting. Methods A retrospective review of a prospectively collected database of all screening colonoscopies was performed at a single endoscopy unit. The patients were divided into two groups; group A included patients in whom the extent of examination was the cecum and group B comprised of those who underwent ileal intubation as well. We summarized the endoscopic and pathological findings of the ileoscopic examinations and their clinical impact. Univariate and multivariate analyses were used to compare both groups and to identify factors predictive of ileal intubation in the setting of screening colonoscopy. Results Two thousand four hundred seventy-three unique completed screening colonoscopies were analyzed (group A=1465 patients, group B=1008 patients). Overall Ileal intubation rate was 40.8%. Of the patients in group B, 3.7% were noted to have findings on ileoscopy, which were deemed to be clinically significant in almost half (1.8% overall). Univariate analysis identified the following factors as being predictive of ileal intubation during screening colonoscopy: patients' age (51.7 vs. 53.5 years, p<0.001), short cecal insertion time, endoscopists' specialty (gastroenterology 42.3% vs. surgery 24.3%, p<0.001), type of colonoscope (pediatric 47.1% vs. adult 33.5% colonoscope, p<0.001), and quality of preparation in the right colon (poor vs. adequate/good : (25.6% vs. 42.5%, p<0.001). Mixed-effects logistic regression identified patients' age, endoscopist specialty, quality of right colon preparation, and cases with short insertion time as independent variables predicting ileal intubation during SC Conclusion The clinical yield of routine ileal intubation during screening colonoscopy is low. Ileal intubation during screening colonoscopy in our cohort was more likely in younger patients with adequate/good right colon preparation and when the exam is performed by a gastroenterologist, in cases with short insertion time. Prospective studies are needed to assess our research findings and to determine the clinical value of routinely intubating terminal ileum during screening colonoscopy in the population of the Middle East.
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Rosevics L, Ramos Júnior O. ILEOSCOPY: WHEN ILEAL EVALUATION IS NOT MANDATORY DURING COLONOSCOPY. ARQUIVOS DE GASTROENTEROLOGIA 2021; 58:175-179. [PMID: 34231662 DOI: 10.1590/s0004-2803.202100000-30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 02/02/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Ileitis is defined as ileal inflammation, with several etiologies, including inflammatory bowel disease (IBD), and can be evaluated during the colonoscopy exam, but its mandatory evaluation is discussed, because of few diagnosis and procedure time. OBJECTIVE This study aims to evaluate the correlation of colonoscopic ileitis with the clinical presentation, in order to identify the cases where ileal examination is mandatory. METHODS A retrospective, cross-sectional study was conducted between 2013 and 2017. The examination report, indications for colonoscopy, and medical records were evaluated in order to identify whether the colonoscopic findings were clinically significant. Patients over 18 years of age who had undergone ileoscopy were included, whereas patients below 18 years of age, those with previous intestinal resections, and repeated examinations of the same patient in the study period were excluded. The estimated association measure was the odds ratio with 95% confidence intervals. P-values <0.05 indicated statistical significance. RESULTS A total of 3382 cases were included. Among these participants, 64.5% were females and the average age was 56.9±13.1 years (18-89 years). Ileal alterations were observed in 5.3% of the patients, with 2.69% being clinically significant between all patients, and 0.96% excluding those with IBD. There was a positive correlation between the ileitis findings and IBD control examinations and a negative correlation in screening and change in bowel habit indications. Among the indications with ileitis clinically significant, IBD control still had a positive correlation, 'diarrhea' and 'others' did not show a statistical significance, and all other indications presented a negative correlation for ileal assessment. CONCLUSION Ileal evaluation in only mandatory in IBD control. When the main colonoscopy objective is detecting colonic neoplasms, ileoscopy is unnecessary.
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Affiliation(s)
- Leticia Rosevics
- Universidade Federal do Paraná, Hospital de Clínicas, Curitiba, PR, Brasil
| | - Odery Ramos Júnior
- Universidade Federal do Paraná, Hospital de Clínicas, Curitiba, PR, Brasil
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Rosevics L, Kotze LR, Ramos Júnior O. ILEITIS - DO ENDOSCOPIST AND PATHOLOGIST SPEAK THE SAME LANGUAGE? ARQUIVOS DE GASTROENTEROLOGIA 2021; 58:145-149. [PMID: 34231660 DOI: 10.1590/s0004-2803.202100000-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 01/30/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Ileitis is defined as an inflammation of the ileum, which is evaluated during colonoscopy. Biopsies should be performed on altered ileus, aiding to the diagnosis. OBJECTIVE Evaluate the correlation of anatomopathological findings on ileitis between pathologists and endoscopists. METHODS A retrospective, cross-sectional study, between 2013 and 2017. Examination report, indications for colonoscopy, and medical records were evaluated to identify whether the colonoscopic findings were clinically significant. Anatomopathological samples were reviewed by a pathologist expert in gastrointestinal tract. Patients over 18 years of age who had undergone ileoscopy were included, whereas patients below 18 years of age and those with previous intestinal resections were excluded. The correlation was assessed using the kappa coefficient index. RESULTS A total of 5833 colonoscopies were conducted in the study period and 3880 cases were included. Ileal alterations were observed in 206 cases, with 2.94% being clinically significant. A hundred and sixty three biopsies were evaluated using the kappa index, resulting in agreement among pathologists of 0.067 and among pathologist and endoscopist of 0.141. CONCLUSION It was observed that despite the low concordance between pathologists and endoscopists, there was no change in patient outcomes. This study confirms the importance of knowledge of the main anatomopathological changes related to ileitis by pathologists and endoscopists, making the best diagnosis and follow-up.
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Affiliation(s)
- Leticia Rosevics
- Universidade Federal do Paraná, Hospital de Clínicas, Curitiba, PR, Brasil
| | - Luiz Roberto Kotze
- Universidade Federal do Paraná, Hospital de Clínicas, Curitiba, PR, Brasil
| | - Odery Ramos Júnior
- Universidade Federal do Paraná, Hospital de Clínicas, Curitiba, PR, Brasil
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Lim HJ, Do Kim H, Soh JS, Kim SY, Jung YJ, Lim H, Kang HS, Kim JH. Discrete terminal ileal ulcers in patients diagnosed with ulcerative colitis: clinical significance and natural course. BMC Gastroenterol 2021; 21:285. [PMID: 34247574 PMCID: PMC8274030 DOI: 10.1186/s12876-021-01866-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/04/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Terminal ileal (TI) ulcers are occasionally detected in asymptomatic individuals and mostly resolve without any treatment. In patients with ulcerative colitis (UC), TI ulcers are infrequently observed without evidence of backwash ileitis. However, the clinical significance and natural course of the lesions are unclear. The aim of our study was to evaluate the frequency and clinical implications of TI ulcers in patients with UC. METHODS We retrospectively reviewed 397 patients with UC via successful TI intubation during colonoscopy. We compared the clinical characteristics of patients manifesting TI ulcers with those who did not. The natural course of TI lesions was also investigated during the follow-up periods. RESULTS Forty-one patients (10.3%) showed TI ulcers without evidence of inflammation in the right colon. The patients with and without TI ulcers were not different in terms of baseline characteristics, disease activity and extent at the time of the UC diagnosis, proximal extension, Mayo endoscopic score at the last endoscopic examination, medication history, UC-related hospitalization, and relapse during follow-up periods. Of the 30 patients who underwent follow-up colonoscopy in patients with TI ulcers, 23 (76.7%) showed resolution of TI ulcer. In addition, patients with remaining TI ulcers did not differ in disease activity and biopsy results compared with those with resolving TI ulcers. CONCLUSIONS Discrete TI ulcers are more common in patients with UC, compared with the healthy cohort. No significant clinical impact on disease extension and severity is found.
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Affiliation(s)
- Hyo-Jin Lim
- Department of Internal Medicine, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170-gil, Dongan-gu, Anyang, 14068, Republic of Korea
| | - Hyun Do Kim
- Department of Internal Medicine, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170-gil, Dongan-gu, Anyang, 14068, Republic of Korea
| | - Jae Seung Soh
- Department of Internal Medicine, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170-gil, Dongan-gu, Anyang, 14068, Republic of Korea.
| | - Sung-Yeun Kim
- Department of Internal Medicine, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170-gil, Dongan-gu, Anyang, 14068, Republic of Korea
| | - Ye-Ji Jung
- Department of Internal Medicine, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170-gil, Dongan-gu, Anyang, 14068, Republic of Korea
| | - Hyun Lim
- Department of Internal Medicine, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170-gil, Dongan-gu, Anyang, 14068, Republic of Korea
| | - Ho Suk Kang
- Department of Internal Medicine, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170-gil, Dongan-gu, Anyang, 14068, Republic of Korea
| | - Jong Hyeok Kim
- Department of Internal Medicine, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170-gil, Dongan-gu, Anyang, 14068, Republic of Korea
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Analysis and Follow up of Endoscopy Results in 1099 Patients with Terminal Ileum Lesions. Can J Gastroenterol Hepatol 2020; 2020:8838613. [PMID: 33354558 PMCID: PMC7735820 DOI: 10.1155/2020/8838613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 11/09/2020] [Accepted: 11/17/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE We aim to analyze the diagnostic yield, diagnostic accuracy, and delayed diagnosis of patients with terminal ileum lesions, providing follow-up suggestions for suspected patients. METHODS We carried out an analysis of 1099 patients who had terminal ileum lesions in our hospital from 2009 to 2019. The endoscopy reports and histopathology reports of terminal ileal biopsies were recorded. Clinical diagnosis and management were reviewed to determine whether there was a need to correct after a follow-up endoscopy result. RESULTS A total of 1099 patients were found to have terminal ileum lesions, among which 959 in 1099 patients (87.26%) were diagnosed as benign, 17 in 1099 patients (1.55%) were diagnosed as malignant, and 123 in 1099 patients (11.19%) were diagnosed as suspected. The diagnostic accuracies of terminal ileal polyp, cyst, cancer, eosinophilic enteritis, parasite, lymphofollicular hyperplasia, and amyloidosis were 100%. The diagnosis was delayed in 9.93% of Crohn's disease (CD) and 12.5% of lymphoma. Among the definite cases, the diagnosis was corrected during the follow-up in 12.5% of the patients, while the clinical treatment was corrected during the follow-up in 17.86% of the patients. Among the suspected cases, the diagnosis and treatment was corrected in 61.11% of the patients during the follow-up. CONCLUSION Coincident diagnosis of ileitis and ileum ulcer is low. Delayed diagnosis of Crohn's disease and lymphoma were observed in a certain proportion of patients with terminal ileum lesions. A follow-up endoscopy was strongly recommended for these suspected patients with terminal ileum lesions.
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Leiman DA, Jawitz NG, Lin L, Wood RK, Gellad ZF. Terminal ileum intubation is not associated with colonoscopy quality measures. J Gastroenterol Hepatol 2020; 35:1503-1508. [PMID: 32003060 DOI: 10.1111/jgh.14997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/08/2020] [Accepted: 01/27/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIM Intubation of the terminal ileum (TI) demonstrates a complete colonoscopy, but its clinical value during screening exams is unknown. We aimed to determine whether TI intubation during screening colonoscopy is associated with colonoscopy quality measures or identifies subclinical pathology. METHODS We performed a retrospective cohort study examining average-risk screening colonoscopies performed at an academic health system between July 2016 and October 2017. Data were extracted from an internal colonoscopy quality registry and the electronic health record. Appropriate statistical tests were used for group comparisons, to correlate TI intubation rate (TIIR) with measures of colonoscopy quality and to examine factors associated with the likelihood of TI intubation. RESULTS There were 7799 colonoscopies performed with adequate prep quality by 28 gastroenterologists. Most patients were female (56.4%) with a median age of 58. The median TIIR was 37.0%, with significant variability among physicians (2-93%). The detection rates for all polyps, adenomas, and sessile serrated polyps were 62.1%, 45.5%, and 7.2%, respectively, and none correlated with TIIR. Intubation of the TI was associated with significantly longer withdrawal times. In a random 10% sample of cases with TI intubation, no clinically significant pathology was found. CONCLUSIONS There is wide variability in TIIR among endoscopists. Except to provide photodocumentation of exam extent when other images may be difficult to obtain, the lack of correlation between TI intubation and meaningful clinical outcomes together with the associated time costs suggest routine TI intubation during screening colonoscopy may not be warranted.
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Affiliation(s)
- David A Leiman
- Division of Gastroenterology, Duke University, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Nicole G Jawitz
- Division of Gastroenterology, Duke University, Durham, North Carolina, USA
| | - Li Lin
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Richard K Wood
- Division of Gastroenterology, Duke University, Durham, North Carolina, USA
| | - Ziad F Gellad
- Division of Gastroenterology, Duke University, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA.,Division of Gastroenterology, Durham VA Health Care System, Durham, North Carolina, USA
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Abu Baker F, Z’cruz De La Garza JA, Nafrin S, Mari A, Suki M, Ovadia B, Gal O, Kopelamn Y. Can microscopic ileitis in patients with clinically suspected inflammatory bowel disease predict the future? BMC Gastroenterol 2020; 20:52. [PMID: 32138683 PMCID: PMC7059716 DOI: 10.1186/s12876-020-01207-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 02/24/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The implication of microscopic ileitis finding in patients referred for ileocolonoscopy for clinically suspected inflammatory bowel disease (IBD) is not well defined, and its correlation with clinical outcome has not been fully studied. The current study aims to determine the prognostic yield of biopsies in this setting, and to evaluate the correlation of microscopic ileitis with long-term clinical outcome. METHODS We reviewed endoscopic reports of patients referred to our department for ileocolonoscopy in the years 2010-2016, as part of a diagnostic work-up for suspected IBD. Patients whose ileocolonoscopies proved normal were included, provided that terminal ileum biopsies had been performed. Accordingly, patients were divided into groups classified as normal (normal or reactive changes) and microscopic ileitis (inflammation or ileitis of any severity). Both groups were followed prospectively to determine clinical outcome. RESULTS A total of 439 patients met the inclusion criteria. Sixty-four (14.6%) showed inflammation on biopsy and were included in the microscopic ileitis group. Age range and gender figures did not differ significantly between the groups. Overall follow-up period was 6.1 ± 2.3 years. Patients in the microscopic ileitis group were significantly associated with Crohn's diagnosis during the follow-up period compared with the normal group (19% vs 2%, OR = 11.98, 95%CI = 4.48-32.01; p < 0.01). Patients with granuloma or moderate-severe ileitis on biopsy were significantly associated with Crohn's development (100% vs 11%; P < 0.01) compared with mild or nonspecific inflammation. CONCLUSION The discovery of microscopic ileitis in clinically suspected IBD is associated with increased risk of future diagnosis of Crohn's disease.
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Affiliation(s)
- Fadi Abu Baker
- grid.414084.d0000 0004 0470 6828Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center (Affiliated to the Technion Faculty of Medicine, Haifa, Israel), Ha-Shalom St, 38100 Hadera, Israel
| | - Jesus Alonso Z’cruz De La Garza
- grid.414084.d0000 0004 0470 6828Department of Surgery, Hillel Yaffe Medical Center (Affiliated to the Technion Faculty of Medicine, Haifa, Israel), Hadera, Israel
| | - Smadar Nafrin
- grid.414084.d0000 0004 0470 6828Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center (Affiliated to the Technion Faculty of Medicine, Haifa, Israel), Ha-Shalom St, 38100 Hadera, Israel
| | - Amir Mari
- Department of Gastroenterology, Nazareth EMMS Hospital (Affiliated with the Faculty of Medicine, Bar Illan University), Nazareth, Israel
| | - Muhammed Suki
- grid.414084.d0000 0004 0470 6828Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center (Affiliated to the Technion Faculty of Medicine, Haifa, Israel), Ha-Shalom St, 38100 Hadera, Israel
| | - Baruch Ovadia
- grid.414084.d0000 0004 0470 6828Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center (Affiliated to the Technion Faculty of Medicine, Haifa, Israel), Ha-Shalom St, 38100 Hadera, Israel
| | - Oren Gal
- grid.414084.d0000 0004 0470 6828Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center (Affiliated to the Technion Faculty of Medicine, Haifa, Israel), Ha-Shalom St, 38100 Hadera, Israel
| | - Yael Kopelamn
- grid.414084.d0000 0004 0470 6828Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center (Affiliated to the Technion Faculty of Medicine, Haifa, Israel), Ha-Shalom St, 38100 Hadera, Israel
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Goulart RDA, Barbalho SM, Gasparini RG, de Carvalho ADCA. Facing Terminal Ileitis: Going Beyond Crohn's Disease. Gastroenterology Res 2016; 9:1-9. [PMID: 27785317 PMCID: PMC5051106 DOI: 10.14740/gr698w] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2016] [Indexed: 12/12/2022] Open
Abstract
Terminal ileitis (TI) is an inflammatory condition of the terminal portion of the ileum that may occur acutely with right lower quadrant pain followed or not by diarrhea, or exhibit chronic obstructive symptoms and bleeding and normally it is associated to Crohn's disease (CD) although it may be associated to other different conditions. This review intended to contribute to a better understanding of TI in order to help in the diagnosis, medical approach and patient care. This work was performed on a survey of articles collected in different databases and a retrospective search was carried out to identify relevant studies in the field. Pathological conditions such as ulcerative colitis, the intake of non-steroidal anti-inflammatory drugs, infectious diseases, eosinophilic enteritis, malignant diseases, spondyloarthropathies, vasculitides, ischemia, sarcoidosis, amyloidosis and others may be related to ileitis but it is commonly referred to CD. To a correct therapeutic approach, it is necessary to understand the causes of this inflammation process. The performance of a clinical, laboratory, endoscopic, and histopathological evaluation of the individuals is crucial to the correct diagnosis and treatment once the inflammation of the ileum may occur due to different pathological conditions besides CD, leading to difficulties in the diagnosis. Thus, an individual approach is necessary once the correct diagnosis is crucial for the immediate therapeutic approach and recovering of the patient.
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Affiliation(s)
- Ricardo de Alvares Goulart
- Department of Gastroenterology, University Hospital - UNIMAR, Higino Muzzi Filho Avenue, 1001, Marilia, SP, Brazil
| | - Sandra Maria Barbalho
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marilia and Food Technology School (FATEC), Higino Muzzi Filho Avenue, 1001, Marilia, SP, Brazil
| | - Rodrigo Galhardi Gasparini
- Department of Gastroenterology, University Hospital - UNIMAR, Higino Muzzi Filho Avenue, 1001, Marilia, SP, Brazil
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Velidedeoğlu M, Enes Arıkan A, Kağan Zengin A. Diagnostic value of terminal ileum biopsies in patients with abnormal terminal ileum mucosal appearance. ULUSAL CERRAHI DERGISI 2015; 31:152-6. [PMID: 26504419 DOI: 10.5152/ucd.2015.2756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 12/21/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the necessity of obtaining routine ileal biopsy during colonoscopy in the patients with abnormal terminal ileum mucosal appearance if the inflammatory bowel disease is not considered. MATERIAL AND METHODS A retrospective analysis was performed for 57 patients who were referred to a private hospital for colonoscopy between January 2008 and February 2009, in whom terminal ileum intubation was achieved and an abnormal appearance was observed. RESULTS There were 33 men and 24 women; the mean age was 44.12±11.42 years. In 22 patients, the abnormality was ulcers and/or erosions. In 10 patients, there were mucosal nodularity and in 24, the finding was erythema. The time to reach to ileum from cecum was 28.78±24.30 s. The mean length of the examined ileum was 12.93±6.05 cm. There was no difference between groups according to distance covered in the ileum for diagnostic yield, but going further than 2 cm was important. CONCLUSION There should be no need to obtain routine biopsy in patients with abnormal terminal ileum mucosa appearance, when inflammatory bowel disease is not considered. In these patients, histopathology also reveals non-specific ileitis. Furthermore, in these patients, the macroscopic pathological diagnosis overlaps the histopathology, and it has a low diagnostic yield and lower clinical significance.
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Affiliation(s)
- Mehmet Velidedeoğlu
- Department of General Surgery, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - A Enes Arıkan
- Department of General Surgery, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - A Kağan Zengin
- Department of General Surgery, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
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Neilson LJ, Bevan R, Panter S, Thomas-Gibson S, Rees CJ. Terminal ileal intubation and biopsy in routine colonoscopy practice. Expert Rev Gastroenterol Hepatol 2015; 9:567-74. [PMID: 25582839 DOI: 10.1586/17474124.2015.1001744] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This special report focuses on the current literature regarding the utility of terminal ileal (TI) intubation and biopsy. The authors reviewed the literature regarding the clinical benefit of TI intubation at the time of colonoscopy and also the evidence for TI intubation as a colonoscopy quality indicator. TI intubation is useful to identify ileal diseases such as Crohn's disease and additionally as a means of confirming colonoscopy completion when classical caecal landmarks are not confidently seen. Previous studies have demonstrated that TI intubation has variable yield but may be more useful in patients presenting with diarrhea. Reported rates of TI intubation at colonoscopy vary. The authors demonstrate that terminal ileoscopy is feasible in clinical practice and sometimes yields additional clinical information. Additionally it may be used as an indicator of colonoscopy completion. It may be particularly helpful when investigating patients with diarrhea, abnormalities seen on other imaging modalities and patients with suspected Crohn's disease. TIs reported as normal at endoscopy have a low yield when biopsied; however, biopsies from abnormal-looking TIs demonstrate a higher yield and have greater diagnostic value.
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Ahammed SM, Das K, Sarkar R, Dasgupta J, Bandopadhyay S, Dhali GK. Patient-posture and Ileal-intubation during colonoscopy (PIC): a randomized controlled open-label trial. Endosc Int Open 2014; 2:E105-10. [PMID: 26135254 PMCID: PMC4423309 DOI: 10.1055/s-0034-1365541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 01/31/2014] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND AND AIMS Patient's posture change is commonly employed by a colonoscopist to achieve complete examination. We studied whether patient's posture (left-lateral decubitus vs supine) influenced the success rate of ileal intubation. PATIENTS AND METHODS In this prospective open-label randomized study performed in the Endoscopy Suite of a tertiary-care center, all adult outpatients referred for colonoscopy, in whom cecal intubation was achieved and who satisfied predefined inclusion criteria, were randomized to undergo ileal intubation in either of the above two postures. Colonoscopy (EC-201 WL, Fujinon) was performed after overnight poly-ethylene-glycol preparation, under conscious sedation and continuous pulse-oxymetry monitoring. After confirming cecal intubation, patients were randomized for ileal intubation. Success was defined by visualization of ileal mucosa or villi (confirmed by digital photography) and was attempted until limited by pain and/or time of ≥ 6 min. RESULTS Of 320 eligible patients, 217 patients (150 males) were randomized, 106 to left-lateral decubitus and 111 to supine posture. At baseline, the two groups were evenly matched. Successful ileal intubation was achieved in 145 (66.8 %) patients overall, significantly higher in the supine posture (74.8 % versus 58.5 %; P = 0.014). On multivariate analysis, supine posture (P = 0.02), average/good right-colon preparation (P < 0.01), non-thin-lipped ileocecal (IC) valve (P < 0.001) and younger age (P = 0.02) were independent predictors of success. Positive ileal findings were recorded in 13 (9 %) patients. CONCLUSION Ileoscopy is more successful in supine than in left-lateral decubitus posture. Age, bowel preparation and type of IC valve also determine success.
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Affiliation(s)
- Sk Mahiuddin Ahammed
- Division of Gastroenterology, School of Digestive and Liver Diseases, IPGME and R, Kolkata, West Bengal, India
| | - Kshaunish Das
- Division of Gastroenterology, School of Digestive and Liver Diseases, IPGME and R, Kolkata, West Bengal, India
| | - R. Sarkar
- Division of Gastroenterology, School of Digestive and Liver Diseases, IPGME and R, Kolkata, West Bengal, India
| | - J. Dasgupta
- Division of Gastroenterology, School of Digestive and Liver Diseases, IPGME and R, Kolkata, West Bengal, India
| | - S. Bandopadhyay
- Division of Gastroenterology, School of Digestive and Liver Diseases, IPGME and R, Kolkata, West Bengal, India
| | - G. K. Dhali
- Division of Gastroenterology, School of Digestive and Liver Diseases, IPGME and R, Kolkata, West Bengal, India
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Koksal AR, Boga S, Alkim H, Ergun M, Bayram M, Sakiz D, Ozdogan O, Altinkaya E, Alkim C. How does a biopsy of endoscopically normal terminal ileum contribute to the diagnosis? Which patients should undergo biopsy? Libyan J Med 2014; 9:23441. [PMID: 24560378 PMCID: PMC3930941 DOI: 10.3402/ljm.v9.23441] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/10/2014] [Accepted: 01/11/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Terminal ileum endoscopy and biopsy are the diagnostic tools of diseases attacking the ileum. However, abnormal histological findings can be found in endoscopically normal terminal ileum. OBJECTIVE This study was performed to evaluate the histopathological results of biopsies from endoscopically normal terminal ileum in order to determine pre-procedure clinical and laboratory factors predicting abnormal histopathological results, if any. METHODS A total of 297 patients who underwent colonoscopy and terminal ileum biopsy and had normal terminal ileum or a few aphthous ulcers in the terminal ileum together with completely normal colon mucosa were included in the study. The patients were grouped into two arms as normal cases and cases with aphthous ulcers. Histopathological and pre-procedural laboratory results of patients were analyzed according to their indications. RESULTS The terminal ileum was endoscopically normal in 200 patients, and 97 patients had aphthous ulcers. Chronic ileitis rate was present in 5.5% of those with endoscopically normal terminal ileum and in 39.2% of the patients with aphthous ulcers. In both groups, the highest rate of chronic ileitis was detected in the patients with known inflammatory bowel disease (IBD) (15.4 and 50%, respectively), anemia (9.5 and 43.5%, respectively), and in the patients having chronic diarrhea together with abdominal pain (7.7 and 44.8%, respectively). We found that the sensitivity of mean platelet volume for predicting chronic ileitis was 87% and the specificity was 45% at a cut-off value lower than 9.35 fl. CONCLUSION In anemia indication or chronic diarrhea together with abdominal pain, the frequency of aphthous ulcers detected by ileoscopy and the frequency of chronic ileitis detected histopathologically despite a normal-appearing ileum were elevated.
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Affiliation(s)
- Ali Riza Koksal
- Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey;
| | - Salih Boga
- Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Huseyin Alkim
- Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Meltem Ergun
- Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Bayram
- Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Damlanur Sakiz
- Department of Pathology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Osman Ozdogan
- Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Engin Altinkaya
- Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Canan Alkim
- Department of Gastroenterology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
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Usefulness of Routine Terminal Ileoscopy and Biopsy during Colonoscopy in a Tropical Setting: A Retrospective Record-Based Study. Gastroenterol Res Pract 2014; 2014:343849. [PMID: 24550980 PMCID: PMC3914407 DOI: 10.1155/2014/343849] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 12/14/2013] [Accepted: 12/15/2013] [Indexed: 12/20/2022] Open
Abstract
Introduction. Available evidence for routine terminal ileoscopy during colonoscopy is equivocal. We investigated the place of routine terminal ileoscopy and biopsy during colonoscopy, in a tropical setting. Materials and Methods. All consenting adults undergoing colonoscopy had routine TI and biopsy. Patients with right iliac fossa (RIF) pain, diarrhoea, anaemia, suspected inflammatory bowel disease (IBD), and raised inflammatory markers were defined as Group A and all others undergoing colonoscopy as Group B. Results. Caecal intubation and TI were achieved in 988/1096 (90.15%) and 832/1096 (75.9%) cases, respectively. 764/832(91.8%) patients were included in final analysis. 81/764 (10.6%) patients had either macroscopic (34/81) or microscopic (47/81) abnormalities of terminal ileum; 20/81 had both. These were CD (28/47), tuberculosis (TB) (6/47), ileitis due to resolving infection (8/47), and drug-induced ileitis (5/47). 27/81 with macroscopically normal ileum had CD (18/27), ileitis due to resolving infection (5/27) and drug-induced ileitis (4/27) on histology. 12/764 (1.57%) patients with macroscopically normal colon had ileal CD (8/12), drug-induced ileitis (2/12), and resolving ileal infection (2/12) on histology. 47/764 (6.15%) patients had ileal pathology that influenced subsequent management. These were significantly higher in Group A (43/555 (8%)) than in Group B (4/209 (1.9%)) (P = 0.0048, χ2 = 7.968).
Conclusion. TI and biopsy improve diagnostic yield of colonoscopy in patients with RIF pain, diarrhoea, anaemia, suspected IBD, and raised inflammatory markers.
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Melton SD, Feagins LA, Saboorian MH, Genta RM. Ileal biopsy: Clinical indications, endoscopic and histopathologic findings in 10,000 patients. Dig Liver Dis 2011; 43:199-203. [PMID: 20843753 DOI: 10.1016/j.dld.2010.08.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 07/22/2010] [Accepted: 08/05/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ileal biopsies are often reported as having a low yield. Data from endoscopy practices in the private setting are lacking. AIMS To correlate the frequency of histologic abnormalities in ileal biopsies with clinical indications and ileoscopic appearances. METHODS Retrospective analysis of clinical, endoscopic, and histopathologic data from a large database. RESULTS We studied 9785 unique adult patients (median age 46 years, 61.4% women) with ileal biopsies. The most common symptoms were diarrhoea (52.2%) and abdominal pain (37.1%). Ileoscopy was reported as being normal in 75.1% patients. Subjects screened for cancer had the highest prevalence of abnormal endoscopic findings (63.3%); patients with known or suspected Crohn's had the highest prevalence abnormal ileal histology (36.4%). Overall, 5.0% of ileal biopsies obtained from patients with normal endoscopy and 47.4% of biopsies from patients with an endoscopically abnormal ileum had significant histopathologic findings. CONCLUSIONS In adults, biopsies from the endoscopically normal ileum rarely provide clinically relevant information and cannot be recommended. In contrast, half of the adult patients with an endoscopically abnormal ileum have significant histopathologic findings in ileal biopsies. Therefore, ileoscopy associated with a sensible use of the ileal biopsy is a valuable complement to the colonoscopy.
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Affiliation(s)
- Shelby D Melton
- Department of Pathology, Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX 75216, USA
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Carmack SW, Genta RM. The diagnostic value of the duodenal biopsy: a clinico-pathologic analysis of 28,000 patients. Dig Liver Dis 2010; 42:485-9. [PMID: 20036203 DOI: 10.1016/j.dld.2009.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 11/20/2009] [Accepted: 11/24/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Duodenal biopsies are frequently obtained to investigate malabsorption, diarrhoea, and anemia. The proportion of patients who have duodenal biopsies and their diagnostic yield are unclear. AIMS To determine what proportion of patients undergoing esophagogastroduodenoscopy in a private setting has duodenal biopsies and to evaluate the diagnostic yield relative to clinical indications and endoscopic findings. METHODS Records of patients who had duodenal biopsies diagnosed at a United States gastrointestinal pathology laboratory in a single year were analysed. RESULTS 28,210 patients with and 75,175 without duodenal biopsies were studied. Duodenal biopsy patients were younger (52 years versus 58 years, p<0.001) and more likely to be female (OR 1.46; p<0.0001); 87% of children and 27% of adults had duodenal biopsies. Suspicion of malabsorption or sprue, diarrhoea, anemia, and weight loss were strong predictors of duodenal biopsy. More than 80% of patients had normal duodenum, except those biopsied for sprue, 64% of whom had normal findings. Marsh II-IIIc lesions were diagnosed in 23% of patients with suspected sprue, but in 3.0% of those with diarrhoea, weight loss, or anemia, and in 1.5% of patients with dyspepsia or GERD. CONCLUSIONS A clinical suspicion of sprue produces the highest yield of histopathologic abnormalities; women are biopsied more often than men despite having less duodenal pathology.
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Affiliation(s)
- Susanne W Carmack
- Division of Gastrointestinal Pathology, Caris Diagnostics, Irving, TX 75063, USA
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Shen B, Khan K, Ikenberry SO, Anderson MA, Banerjee S, Baron T, Ben-Menachem T, Cash BD, Fanelli RD, Fisher L, Fukami N, Gan SI, Harrison ME, Jagannath S, Lee Krinsky M, Levy M, Maple JT, Lichtenstein D, Stewart L, Strohmeyer L, Dominitz JA. The role of endoscopy in the management of patients with diarrhea. Gastrointest Endosc 2010; 71:887-92. [PMID: 20346452 DOI: 10.1016/j.gie.2009.11.025] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Accepted: 11/13/2009] [Indexed: 02/08/2023]
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Baraza W, Brown S, Shorthouse AJ, Tiffin N, Hurlstone DP. Direct photographic documentation of ileal mucosa in routine colonoscopy is not an independent valid or reliable proof of completion: quality assurance issues for the national colorectal cancer-screening programme. Colorectal Dis 2009; 11:89-93. [PMID: 18400041 DOI: 10.1111/j.1463-1318.2008.01511.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The implementation of bowel cancer screening in the UK requires the maintenance of high standards in colonoscopy. Part of this quality control requires the reliable documentation of complete colonoscopy that can be externally audited and assessed. It has been suggested that terminal ileal biopsy is the only definitive and reliable method of confirming caecal intubation, but it is not cost-effective and may now be contraindicated because of potential prion infection. OBJECTIVE To determine how reliable routine terminal ileal images were as an independent predictor of complete colonoscopy and whether their interpretation was aided with water insufflation or indigo-carmine dye-spraying. Method Forty-nine histologically confirmed terminal ileal images were obtained from a single endoscopist's database; 19 were conventional white-light images, 15 were taken with water insufflation and 15 were taken using chromoscopy enhancement. The images were transferred onto CD-ROM and sent as a questionnaire to 42 colonoscopists who were asked to identify the images as terminal ileum or not. RESULTS Twenty questionnaires were returned resulting in a total of 980 responses. Overall, the accuracy of positive identification was 53.4%. Water insufflation and chromoscopy improved the accuracy to 68.3% and 63% respectively. Experience of (> 1000 colonoscopies) did not increase overall accuracy. Less experienced endoscopists had an increased accuracy rate with dye-spraying (76.7%vs 59.3%, P < 0.05) but experienced endoscopists had an increased accuracy rate with water insufflation (67.4%vs 63.3%, P > .05). CONCLUSION Currently, terminal ileal imaging is not a reliable mode of documenting complete colonoscopy. Using water insufflation or dye-spraying coupled with modifications in image acquisition technique may improve its reliability but these methods require further investigation before they can replace the use of caecal landmarks as completion parameters.
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Affiliation(s)
- W Baraza
- Gastroenterology and Liver Unit, Royal Hallamshire Hospital, UK
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Canadian credentialing guidelines for colonoscopy. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2008; 22:17-22. [PMID: 18209776 DOI: 10.1155/2008/837347] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Routine ileal intubation during screening colonoscopy: a useful maneuver? Surg Endosc 2008; 22:2606-8. [DOI: 10.1007/s00464-008-9843-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2007] [Accepted: 01/19/2008] [Indexed: 12/19/2022]
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Jeong SH, Lee KJ, Kim YB, Kwon HC, Sin SJ, Chung JY. Diagnostic value of terminal ileum intubation during colonoscopy. J Gastroenterol Hepatol 2008; 23:51-5. [PMID: 18171342 DOI: 10.1111/j.1440-1746.2007.05151.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIM Since the diagnostic value of ileoscopy is not well documented, it is uncertain if terminal ileum intubation should be performed routinely in patients undergoing colonoscopy. We aimed to assess the diagnostic yield of terminal ileum intubation during colonoscopy according to indications for colonoscopy. METHODS We routinely performed terminal ileum intubation in subjects who underwent colonoscopy at Ajou University Hospital between 1 January 2005 and 31 December 2005. Demographic data, indications for colonoscopy, endoscopic, and histopathologic findings of the terminal ileum were assessed. RESULTS A total of 3921 subjects underwent colonoscopy. The terminal ileum was successfully intubated in 3417 cases (87.1%). Macroscopic abnormality on terminal ileum was present in 125 cases (3.7%), and biopsies were taken for all of them. Clinically significant histopathology was observed in 11 cases, giving a 0.3% diagnostic yield in all ileoscopies. Seven out of 11 cases were diagnosed as Crohn's disease. The rate of diagnostic yield was 1.8% in patients with right lower quadrant (RLQ) abdominal pain and 0.4% in patients with diarrhea. This rate in cases with RLQ pain was significantly greater compared with the indications for medical check-ups. CONCLUSIONS Terminal ileum intubation during colonoscopy identifies significant pathology in 1.8% of cases who have RLQ abdominal pain, suggesting diagnostic value in this setting. However, its diagnostic yield is very low in other indications for colonoscopy. Thus the decision to perform ileoscopy or not during colonoscopy needs to be made on a case-by-case basis.
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Affiliation(s)
- Seong Hyun Jeong
- Department of Gastroenterology, Ajou University Hospital, Suwon, South Korea
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Hinds R, Thomson M. Pediatric ileocolonoscopy training: acquisition of endoscopic skill must be nurtured and objectively assessed within a formalized pediatric framework. J Pediatr Gastroenterol Nutr 2007; 45:1-2. [PMID: 17592357 DOI: 10.1097/mpg.0b013e318054d02d] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Rupert Hinds
- Department of Child Health King's College Hospital London, UK
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