Identification of a terminal ileum carcinoid tumour during bowel screening colonoscopy – should terminal ileoscopy be performed as best practice?

The UK National Bowel Cancer Screening Programme invites men and women aged between 60 – 74 years old to be routinely screened every 2 years. A 90% caecal intubation rate or intubation of the terminal ileum is considered to be the best practice means of identifying completeness. This case report describes how terminal ileal intubation carried out during a routine screening colonoscopy led to the identification and treatment of a carcinoid tumour. Despite evidence for improving colonic diagnoses, completion of colonoscopy by passing through the ileocaecal valve is not performed routinely due to the perceived difficulty of the manoeuvre. With practice, ileoscopy has been shown to be achievable in at least 85% of routine colonoscopies and contributes significantly to quality assurance and to the diagnostic yield.