It is not worthwhile to perform ileoscopy on all patients

Article

Abstract

Background

It remains controversial whether ileoscopy should be attempted in all patients. Although the ease of ileoscopy and the diagnostic yield have been well described, there have been no studies describing the value of the diagnostic yield in altering clinical management. We carried out a study to ascertain whether it is worthwhile to perform ileoscopy in all patients having a colonoscopy.

Methods

We carried out a retrospective study of all patients who had a colonoscopy between January 1, 2002, and December 31, 2003. The patient details, indications, findings, and complications of the procedure were recorded, together with the histopathology reports of colonic and terminal ileal biopsies. Clinical case note of patients with a positive diagnosis was reviewed to ascertain whether there was a change to the patient’s management following an abnormal biopsy result.

Results

A total of 2,149 colonoscopies were performed. In 346 patients (16.1%), the terminal ileum was intubated. There were 16 abnormal findings on histology, which gave a diagnostic yield of 4.6% of all ileoscopies. A change to management occurred in only half of these patients.

Conclusion

Ileoscopy should only be attempted in situations in which the indication is warranted and that would alter management. It is not cost-effective to carry out ileoscopy on all patients.

Keywords

Costs General Endoscopy 

References

  1. 1.
    Ansari A, Soon SY, Saunders BP, Sanderson JD (2003) A prospective study of the technical feasibility of ileoscopy at colonoscopy. Scand J Gastroenterol 38: 1184–1186CrossRefPubMedGoogle Scholar
  2. 2.
    Batres LA, Maller ES, Ruchelli E, et al (2002) Terminal ileum intubation in pediatric colonoscopy and diagnostic value of conventional small bowel contrast radiography in pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr 35: 320–323CrossRefPubMedGoogle Scholar
  3. 3.
    Bramble MG, Ironside JW (2002) Creutzfeldt–Jakob disease: implications for gastroenterology. Gut 50: 888–890CrossRefPubMedGoogle Scholar
  4. 4.
    Kundrotas LW, Clement DJ, Kubik CM, et al (1994) A prospective evaluation of successful terminal ileum intubation during routine colonoscopy. Gastrointest Endosc 40: 544–546PubMedGoogle Scholar
  5. 5.
    Nagasako K, Yazawa C, Takemoto T (1972) Biopsy of the terminal ileum. Gastrointest Endosc 19: 7–10PubMedCrossRefGoogle Scholar
  6. 6.
    Office for National Statistics (2001) Census 2001. Stationary Office, LondonGoogle Scholar
  7. 7.
    Working Party of the British Society of Gastroenterology Endoscopy Committee (2001) Provision of endoscopy related services in district general hospitals, working party reportGoogle Scholar
  8. 8.
    Zwas FR, Bonheim NA, Berken CA, Gray S (1994) Ileoscopy as an important tool for the diagnosis of Crohn’s disease: a report of seven cases. Gastrointest Endosc 40: 89–91PubMedCrossRefGoogle Scholar
  9. 9.
    Zwas FR, Bonheim NA, Berken CA, Gray S (1995) Diagnostic yield of routine ileoscopy. Am J Gastroenterol 90: 1441–1443PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  1. 1.Oldchurch HospitalUK
  2. 2.Tanaka Business SchoolImperial College London, South Kensington CampusUK

Personalised recommendations