Is ileocaecal valve intubation essential at routine colonoscopic examination?

OBJECTIVE AND HYPOTHESIS: Ileoscopy is a part of complete colonoscopy and not performed frequently in routine practice. However, ileoscopy is performed only in 5 % of the patients who underwent colonoscopies and remains optional in clinic practice. Although some authors believe that intubation of the terminal ileum should be attempted in all patients undergoing colonoscopy, others believe that it should be optional. We aimed to assess the diagnostic yield of terminal ileum intubation during routine colonoscopy in this study.METHODS: We routinely performed terminal ileum intubation in all patient who underwent colonoscopy at Dokuz Eylul University Hospital between February 2007 and June 2008. Two gastroenterology fellows performed colonoscopies in the Central Endoscopy Unit. Demographic datas of patients, indications of colonoscopies, caecum and ileum intubation rate/time, endoscopic, and histopathologic findings of the terminal ileum were assessed. According to the variable distribution, Student t-test or Mann?Whitney U-test was used for comparison of groups. Categorical variables were compared by using the chi-square test. Pearson?s correlation analysis was also performed.RESULTS: A total of 1310 consecutive patients (726 female, 584 male, median age: 55.79±14.29 years) underwent colonoscopy in the study period. The colonoscopy was succesfully completed in 1144 (87.3 %) cases. The terminal ileum was successfully intubated in 1032 (90.2 %) cases. The mean time taken to reach the ileum from the caecum was 63.08±64.16 minutes. Endoscopic abnormality on terminal ileum was present in 62 cases (6 %), and biopsies were taken from all of them. However endoscopic abnormality was found in 7 % of patients with symptomatic and 3.3 % of patients with asymptomatic. There were statistically significant difference between symptomatic and asymptomatic patients (p=0.02). Clinically significant histopathologic findings were observed in 22 cases. 12 out of 22 cases were diagnosed as Crohn?s disease.CONCLUSION: Terminal ileum intubation is not essential for all patients undergoing colonoscopy and should be considered for selective indications, for example known or suspected inflammatory bowel disease or chronic diarrhea.KEY WORDS: Colonoscopy, ileocaecal valv intubation, caecal intubation