Terminal ileal intubation and biopsy in routine colonoscopy practice

Abstract

This special report focuses on the current literature regarding the utility of terminal ileal (TI) intubation and biopsy. The authors reviewed the literature regarding the clinical benefit of TI intubation at the time of colonoscopy and also the evidence for TI intubation as a colonoscopy quality indicator. TI intubation is useful to identify ileal diseases such as Crohn’s disease and additionally as a means of confirming colonoscopy completion when classical caecal landmarks are not confidently seen. Previous studies have demonstrated that TI intubation has variable yield but may be more useful in patients presenting with diarrhea. Reported rates of TI intubation at colonoscopy vary. The authors demonstrate that terminal ileoscopy is feasible in clinical practice and sometimes yields additional clinical information. Additionally it may be used as an indicator of colonoscopy completion. It may be particularly helpful when investigating patients with diarrhea, abnormalities seen on other imaging modalities and patients with suspected Crohn’s disease. TIs reported as normal at endoscopy have a low yield when biopsied; however, biopsies from abnormal-looking TIs demonstrate a higher yield and have greater diagnostic value.

Keywords:

• colonoscopy
• ileal biopsy
• ileal intubation
• ileocolonoscopy
• terminal ileum

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Terminal ileal intubation is a useful tool for identifying ileal Crohn’s disease and for confirming colonoscopy completion when classical cecal landmarks are not confidently seen.

• There is currently no guidance available to endoscopists regarding suggested terminal ileal intubation rates.

• TI intubation may be helpful when investigating diarrhea, imaging abnormalities and suspected Crohn’s disease.

• Terminal ileal intubation and photography are a useful means of documenting colonoscopy completion and may be useful where cecal photographs are unconvincing.

• TI biopsies are only recommended where the ileal mucosa appears abnormal or where there is a high pretest probability of Crohn’s disease in patients with an endoscopically normal TI – there is negligible value in biopsying otherwise normal terminal ileal mucosa.