Rutin kolonoskopi uygulanan hastalarda rutin terminal ileum entübasyonunun gerekliliği: Zorunlu mudur?

Abstract

The necessity of routine terminal ileum intubation in patients undergoing routine colonoscopy: Is it a must?

Abstract

Objectives Terminal ileal intubation (TIE) is a useful procedure during colonoscopy, but its clinical value is controversial in the literature. The aim of this study is to investigate the necessity of terminal ileal intubation during colonoscopy in patients not suspected of having inflammatory bowel disease. Methods This study was conducted by retrospectively reviewing data from 872 colonoscopies. Patients with inflammatory bowel disease and those with inadequate bowel preparation were excluded from the study. The demographic data of the patients, colonoscopy results, macroscopic and microscopic findings, and complications were recorded. Results The average age of the 763 patients included in the study was 53.26±23.82 years, with 429 (56.22%) male and 334 (43.78%) female patients. A total of 107 patients (14.02%) underwent TIE. Of the 107 patients who underwent TIE, 56 (52.33%) were female, and 51 (47.67%) were male, with an average age of 49.52±21.69 years. The colonoscopy indications for patients who underwent TIE were diarrhea in 46 patients, rectal bleeding in 38 patients, and abdominal pain in 23 patients. Macroscopic pathological findings were observed in 8 patients (7.46%), and microscopic pathological findings in 3 patients (2.80%). The proportion of patients with microscopic pathological findings accounted for 0.39% of all colonoscopies. Conclusions Our study suggests that while TIE, which requires experience and extends the duration of colonoscopy, may be beneficial for the diagnosis of selected patients, it may not be necessary in routine colonoscopies given its very low diagnostic value.

Keywords

• Colonoscopy
• Terminal Ileum
• Inflammatory Bowel Disease

Ethical Statement

This study was approved by the non-invasive clinical studies ethics committee of Istanbul Training and Research Hospital. (No: 56)

References

1. Okagawa Y, Sumiyoshi T, Hanada K, et al. Is annual screening by fecal immunochemical test necessary after a recent colonoscopy?. DEN Open. 2024;5(1):e385. doi:10.1002/ deo2.385
2. Feng L, Guan J, Dong R, et al. Risk factors for inadequate bowel preparation before colonoscopy: A meta-analysis. J Evid Based Med. 2024;17(2):341-350. doi:10.1111/jebm.12607
3. Hajibandeh S, Hajibandeh S, Regan A, et al. Safety and feasibility of colonoscopy in nonagenarians: A systematic review, meta-analysis and meta-regression analysis. Colorectal Dis. 2024;26(5):871-885. doi:10.1111/codi.16960
4. Jeong SH, Lee KJ, Kim YB, Kwon HC, Sin SJ, Chung JY. Diagnostic value of terminal ileum intubation during colonoscopy. J Gastroenterol Hepatol. 2008;23(1):51-55. doi:10.1111/j.1440-1746.2007.05151.x
5. Siau K, Pelitari S, Green S, et al. JAG consensus statements for training and certification in colonoscopy. Frontline Gastroenterol. 2023;14(3):201-221. doi:10.1136/ flgastro-2022-102260
6. Alkhalidi N, Alrubaie A, Rezqallah R E et al. The Value of Terminal Ileum Intubation During Colonoscopy. J Coloproctol 2022; 42: 59-62. doi: 10.1055/s-0041-1739298
7. Celayir MF, Koksal HM, Tanal M, Uludag M. The necessity of routine terminal ileum intubation during colonoscopy. Gazz Med Ital - Arch Sci Med 2022;181:219-24. doi: 10.23736/ S0393-3660.20.04447-2
8. Borsotti E, Barberio B, D’Incà R, et al. Terminal ileum ileoscopy and histology in patients undergoing highdefinition colonoscopy with virtual chromoendoscopy for chronic nonbloody diarrhea: A prospective, multicenter study. United European Gastroenterol J. 2019;7(7):974-981. doi:10.1177/2050640619847417

9. Armstrong D, Barkun A, Bridges R, et al. Canadian Association of Gastroenterology consensus guidelines on safety and quality indicators in endoscopy. Can J Gastroenterol. 2012;26(1):17- 31. doi:10.1155/2012/173739
10. Rembacken B, Hassan C, Riemann JF, et al. Quality in screening colonoscopy: position statement of the European Society of Gastrointestinal Endoscopy (ESGE). Endoscopy. 2012;44(10):957-968. doi:10.1055/s-0032-1325686
11. Zwas FR, Bonheim NA, Berken CA, Gray S. Diagnostic yield of routine ileoscopy. Am J Gastroenterol 1995;90(9):1441-1443.
12. Yoong KK, Heymann T. It is not worthwhile to perform ileoscopy on all patients. Surg Endosc. 2006;20(5):809-811. doi:10.1007/ s00464-005-0426-9
13. Neilson LJ, Bevan R, Panter S, Thomas-Gibson S, Rees CJ. Terminal ileal intubation and biopsy in routine colonoscopy practice. Expert Rev Gastroenterol Hepatol. 2015;9(5):567-574. doi:10.1586/17474124.2015.1001744
14. Donnellan F, Moran S, Patchett SE. An incidentaloma at ileal intubation. World J Gastrointest Endosc. 2011;3(11):228-230. doi:10.4253/wjge.v3.i11.228
15. Kennedy G, Larson D, Wolff B, Winter D, Petersen B, Larson M. Routine ileal intubation during screening colonoscopy: a useful maneuver? Surg Endosc. 2008;22(12):2606-2608. doi:10.1007/ s00464-008-9843-x
16. Alkhatib AA, Kumar S. Clinical Yield of Ileal Intubation During Screening Colonoscopy. Cureus. 2022;14(1):e20870. doi:10.7759/cureus.20870