New interpretation for diagnostic yield of ileoscopy: A prospective study and a brief review

BACKGROUND: Lower digestive endoscopy is mostly limited to the cecum without any attempt to penetrate the ileum. One of the probable reasons is the expectation of a low diagnostic yield. This study aimed to examine the feasibility of ileoscopy during colonoscopy and its diagnostic yield. METHODS: We prospectively studied 128 consecutive patients, who were referred to Poursina Hakim Research Institute for lower GI disorders evaluation over a four months period, from March to July 2003. We tried to do total colonoscopy and ileal intubation with special attention to the timing and success rate of colonoscopy in each landmark. RESULTS: Out of 128 subjects, successful examination of cecum was done in 120 (93.6%). Out of 120 patients whose cecum was reached and studied, we intended to perform ileal intubation in 99 patients. Successful terminal ileal (TI) intubation was accomplished in 93(93.9 %) of the examinations. Abnormal findings were seen in 4 cases. Normal ileal findings were also helpful in ruling out TI pathology in 78 other patients with abdominal pain, weight loss, lower GI bleeding or colonic inflammation, which made ileoscopy clinically valuable in 82 of 95 normal ileal examinations (86.3%) in this study. CONCLUSIONS: Ileoscopy is safe, fast and feasible, so we recommend it in all symptomatic cases since normal findings are also valuable in patients’ clinical management. Considering normal findings, the routine ileoscopy had surprisingly higher diagnostic yield compared to the results of previous studies.