Usefulness of ileoscopy during Colonoscopy

Abstract

INTRODUCTION AND OBJECTIVES: To investigate utility of ileoscopy during colonoscopy in a cohort of Sri Lankan patients. METHODS: We performed a retrospective analysis of all patients who underwent colonoscopy from January 2007 to September 2010. We compared diagnostic utility of ileoscopy in patients who were considered to have specific clinical indications for ileoscopy (group A) with those who did not (group B). RESULTS: 789 colonoscopies were performed and the terminal ileum was successfully intubated in 638 (80.9%). 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 others of doubtful clinical importance 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 macroscopicalfy normal terminal ileum had abnormal microscopy: Crohn's desease (21), ileitis - resolving infection (3) or drug induced (2), backwash ileitis (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=l , p=0.03S). CONCLUSIONS: Ileoscopy and biopsy during colonoscopy is a useful investigation which detects significant pathology, even in situations where the rest of the colon is normal and the ileum appears macroscopically normal. The procedure should be recommended.