Usefulness of Ileoscopy during Colonoscopy

Abstract

INTRODUCTION: Ileoscopy during colonoscopy adds only three minutes to total procedure time and has no added complications. However, available evidence for recommending the procedure is contradictory. There are few studies adressing this issue in South Asian populations. Aims: To investigate the usefulness of terminal ileoscopy during colonoscopy in a cohort of Sri Lankan patients attending a tertiary care centre. METHODOLOGY: From January 2007, our unit policy was to perform ileoscopy in all patients undergoing colonoscopy. A retrospective analysis of all patients who underwent colonoscopy in the unit from January 2007 to September 2010 was performed. Data were obtained from endoscopy unit and patient records. We compared usefulness of ileoscopy in patients considered to have specific clinical indications for ileoscopy - right iliac fossa pain, diarrhea, anemia, inflammatory bowel disease and raised inflammatory markers (group A) with those that did not (group B). RESULTS: 789 colonoscopies were performed during the study period, and the terminal ileum was successfully intubated in 638 (80.9%). Reasons for not intubating the ileum were technical difficulty and/or severe patient discomfort. Overall, 108/ 638 (16.9%) patients had macroscopic or microscopic abnormalities of the ileum. 51/638 (8%) of these were considered to be significant ileal pathology: Crohn’s disease (34), tuberculosis (5), ileitis-resolving infection (8) or drug induced (4). The other abnormalities, of doubtful clinical importance and which did not alter management, were backwash ileitis in ulcerative colitis (12), and non-specific ileitis (37). 35 patients with ileal abnormalities (Crohn’s disease 6, non-specific ileitis 29) had no abnormalities in the colon. 66 patients with a macroscopically normal terminal ileum had abnormal microscopy: Crohn’s disease (21), ileitis - resolving infection (3) or drug induced (2), backwash ileitis in ulcerative colitis (4), non-specific ileitis (36). In group A [n=511; mean (SD) age 47.7 (16) years; 53.4% males] 47/511 (9.2%) had significant ileal pathology compared to 4/ 127 (3.15%) in group B [n=127; mean (SD) age 53.2 (16) years; 50.4% males] (x2 4.270, df=1, p=0.038). CONCLUSION: Ileoscopy and biopsy during colonoscopy is a useful investigation which detects significant pathology, in some instances where the rest of the colon is normal and sometimes even when the ileum appears macroscopically normal. The procedure should be recommended, especially for patients with right iliac fossa pain, diarrhea, anemia, inflammatory bowel disease and raised inflammatory markers.