Iacopini G, Frontespezi S, Vitale MA, Villotti G, Bella A, d'Alba L, De Cesare A, Iacopini F. Routine ileoscopy at colonoscopy: a prospective evaluation of learning curve and skill-keeping line.
Gastrointest Endosc 2006;
63:250-6. [PMID:
16427930 DOI:
10.1016/j.gie.2005.09.029]
[Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2005] [Accepted: 09/13/2005] [Indexed: 02/08/2023]
Abstract
BACKGROUND
Ileoscopy is the criterion standard for mucosal lesions of terminal ileum but is performed in 5% of colonoscopy activity, and the need for training is undefined.
OBJECTIVE
To assess the learning curve and skill-keeping line of ileoscopy.
DESIGN
Prospective randomized study.
SETTING
Single GI endoscopy unit.
PATIENTS
Adult outpatients referred for colonoscopy.
INTERVENTIONS
Patient randomization to ileocolonoscopy by trainees and seniors.
MAIN OUTCOME MEASUREMENTS
Ileoscopy skill was divided into the following: ileocecal valve (ICV) intubation (success rate, time) and ileal exploration (length, time). Consecutive blocks of 10 procedures were used to calculate the learning curve and the skill-keeping line. Variables considered to influence ICV intubation were the following: endoscopist experience, ICV morphology, patient age, gender, body mass index, diverticular disease, and preceding abdominal/pelvic surgery.
RESULTS
Learning curve showed that competency in ICV intubation (80% success rate) and ileal exploration (16 cm) was achieved after 50 procedures. The skill-keeping line showed that ileoscopy was easy (97% success rate), fast (1 minute), and well accepted up to 45 cm of the ileum. Thin-lipped and volcanic ICV are the most difficult and easiest to intubate, respectively. Crohn's disease and adenomas of the proximal edge of ICV were diagnosed in 2.2%.
CONCLUSIONS
Training in ileoscopy is recommended to achieve competency, and endoscopists should consider practicing ICV intubation to maintain and increase their skill. Ileoscopy can be difficult when the ICV is thin lipped or single bulged, and easy when it has a volcanic morphology.
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