Ileal biopsy: Clinical indications, endoscopic and histopathologic findings in 10,000 patients

Melton, Shelby D.; Feagins, Linda A.; Saboorian, M. Hossein; Genta, Robert M.

doi:10.1016/j.dld.2010.08.004

Cited by 59 publications

(26 citation statements)

References 21 publications

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“…Only two patients who underwent a terminal ileum biopsy alone had abnormal histology, in both cases showing non‐specific ileitis. These findings indicate a low yield of pathology when the endoscopically normal terminal ileum alone is biopsied, consistent with previous studies 9,10 . The Royal College of Pathologists recommend that a photograph is taken to document that the colonoscopist has reached the terminal ileum 1 .…”

Section: Discussionsupporting

confidence: 86%

Specific histological abnormalities are more likely in biopsies of endoscopically normal large bowel after the age of 60 years

2012

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Section: Discussionsupporting

confidence: 86%

Specific histological abnormalities are more likely in biopsies of endoscopically normal large bowel after the age of 60 years

2012

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“…Similarly, in the study of Melton et al (5), the rate of chronic ileitis in the normal endoscopic appearance group was higher in the anemia indication when compared to the abdominal pain, chronic diarrhea, and abnormal radiologic finding indications (6.1 vs. 5.1%).…”

Section: Discussionmentioning

confidence: 56%

“…In the study by Melton et al (5) on the diagnostic value of terminal ileum biopsies, the association between the clinical indication, endoscopic findings, and histopathological findings was evaluated. Based on retrospective data from approximately 10,000 patients, 52.2% of the patients underwent the procedure due to chronic diarrhea.…”

Section: Discussionmentioning

confidence: 99%

How does a biopsy of endoscopically normal terminal ileum contribute to the diagnosis? Which patients should undergo biopsy?

Koksal

Boğa

Alkım

et al. 2014

Libyan Journal of Medicine

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BackgroundTerminal ileum endoscopy and biopsy are the diagnostic tools of diseases attacking the ileum. However, abnormal histological findings can be found in endoscopically normal terminal ileum.ObjectiveThis study was performed to evaluate the histopathological results of biopsies from endoscopically normal terminal ileum in order to determine pre-procedure clinical and laboratory factors predicting abnormal histopathological results, if any.MethodsA total of 297 patients who underwent colonoscopy and terminal ileum biopsy and had normal terminal ileum or a few aphthous ulcers in the terminal ileum together with completely normal colon mucosa were included in the study. The patients were grouped into two arms as normal cases and cases with aphthous ulcers. Histopathological and pre-procedural laboratory results of patients were analyzed according to their indications.ResultsThe terminal ileum was endoscopically normal in 200 patients, and 97 patients had aphthous ulcers. Chronic ileitis rate was present in 5.5% of those with endoscopically normal terminal ileum and in 39.2% of the patients with aphthous ulcers. In both groups, the highest rate of chronic ileitis was detected in the patients with known inflammatory bowel disease (IBD) (15.4 and 50%, respectively), anemia (9.5 and 43.5%, respectively), and in the patients having chronic diarrhea together with abdominal pain (7.7 and 44.8%, respectively). We found that the sensitivity of mean platelet volume for predicting chronic ileitis was 87% and the specificity was 45% at a cut-off value lower than 9.35 fl.ConclusionIn anemia indication or chronic diarrhea together with abdominal pain, the frequency of aphthous ulcers detected by ileoscopy and the frequency of chronic ileitis detected histopathologically despite a normal-appearing ileum were elevated.

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“…Data from endoscopy practice in a private United States setting reported that the TI is sampled in only 5.5% of colonoscopies in which other biopsies were also taken. 16 …”

Section: Discussionmentioning

confidence: 99%

Collagenous Ileitis

O’Brien

McClymont

Brown

2011

American Journal of Surgical Pathology

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Collagenous ileitis (CI), characterized by subepithelial collagen deposition in the terminal ileum, is an uncommon condition. The few cases reported to date have been associated with collagenous colitis (CC) or lymphocytic colitis. Thirteen cases of CI retrieved over a 9-year period were retrospectively studied. There were 7 female and 6 male patients, with an age range of 39 to 72 years (mean, 64 y). Two groups were identified: (1) CI associated with collagenous or lymphocytic disease elsewhere in the gastrointestinal tract and (2) CI as an isolated process. Diarrhea was the presenting symptom in 11 cases. Most patients had no regular medication use. Subepithelial collagen thickness ranged from 15 to 100 μm (mean, 32 μm) and involved 5% to 80% of the subepithelial region of the submitted biopsies. Six cases had >25 intraepithelial lymphocytes (IELs)/100 epithelial cells, and villous blunting was observed in 11 cases. Chronic inflammation of the lamina propria was present in 9 cases, and focal neutrophil infiltration was identified in 3 cases. In biopsies taken from other sites, 7 of 13 colonic biopsies showed CC, 4 of 9 gastric biopsies showed collagenous gastritis, and 2 of 10 duodenal biopsies were abnormal with collagenous sprue (n=1) and partial villous atrophy and increased IELs (n=1) (both celiac disease related). Resolution of the subepithelial collagen deposition was found in the 1 case in which follow-up of terminal ileal biopsies were taken. There was partial or complete resolution of symptoms in 6 of 9 patients for whom follow-up information was available.

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Ileal biopsy: Clinical indications, endoscopic and histopathologic findings in 10,000 patients

Cited by 59 publications

References 21 publications

Specific histological abnormalities are more likely in biopsies of endoscopically normal large bowel after the age of 60 years

Specific histological abnormalities are more likely in biopsies of endoscopically normal large bowel after the age of 60 years

How does a biopsy of endoscopically normal terminal ileum contribute to the diagnosis? Which patients should undergo biopsy?

Collagenous Ileitis

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