Terminal ileum ileoscopy and histology in patients undergoing high‐definition colonoscopy with virtual chromoendoscopy for chronic nonbloody diarrhea: A prospective, multicenter study

Borsotti, Edoardo; Barberio, Brigida; D’Incà, R.; Bonitta, Gianluca; Cavallaro, Flaminia; Pastorelli, Luca; Rondonotti, Emanuele; Samperi, L.; Neumann, Helmut; Viganò, Chiara; Vecchi, Maurizio; Tontini, Gian Eugenio

doi:10.1177/2050640619847417

Cited by 8 publications

(9 citation statements)

References 36 publications

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“…A clear and detailed description of every segment of colon was recorded, including at least two images demonstrating a stable visualization for at least 30 seconds. 18 When subjects had lesions identified at the terminal ileum (eg, congestion, erosion, ulcers), the biopsies were taken and sent for pathological examination under the supervision of nursing staff. The endoscopic equipment used was a gastrointestinal mirror system, CLV-290SL (OLYMPUS, Japan).…”

Section: Methodsmentioning

confidence: 99%

Inverse Association Between Helicobacter pylori Infection and Unexplained Isolated Terminal Ileitis: A Retrospective Study

Lei

Liu

et al. 2021

JIR

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Background: Isolated terminal ileitis (ITI) is a phenomenon often observed during colonoscopy, but in most cases, the specific etiology of ITI is unclear. Helicobacter pylori (H. pylori) infection has been reported to be associated with a wide variety of diseases, especially gastrointestinal diseases. Here, we conducted a retrospective study to explore a potential correlation between H. pylori infection and unexplained ITI (UITI). Materials and Methods: The retrospective study was conducted at Sino-French New City Branch of Tongji Hospital, Wuhan, China, from April 2017 to October 2020. All subjects underwent total colonoscopy, with the endoscope being inserted more than 10cm into the terminal ileum. Subjects also received a 13 C-urea breath test ( 13 C-UBT). Data on the age, gender, endoscopic manifestations, and main clinical symptoms of subjects were collected. The presence of H. pylori infection was defined as a positive 13 C-UBT result. Logistic regression models were used to analyze the potential correlation between H. pylori infection and UITI. Results: There were 247 subjects (25.1%) in the H. pylori (+) group and 739 subjects (74.9%) in the H. pylori (-) group. The prevalence of UITI in the H. pylori (+) group was significantly lower than that in the H. pylori (-) group (OR = 0.518; 95% CI 0.281-0.956; P = 0.035), and there was no difference in other clinical features between groups. Stratification analysis results showed that there was an inverse association between H. pylori infection and UITI in subjects with age <60 (P = 0.046). Conclusion: These data showed that H. pylori infection was negatively correlated with UITI. Additional studies are needed to validate these findings in a larger cohort as well as to explore the underlying mechanisms.

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Section: Methodsmentioning

confidence: 99%

Inverse Association Between Helicobacter pylori Infection and Unexplained Isolated Terminal Ileitis: A Retrospective Study

Lei

Liu

et al. 2021

JIR

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“… 17 , 18 In colonoscopic studies performed for patients with non‐bloody chronic diarrhea, microscopic colitis is the most frequently found disease, followed by IBDs including Crohn's disease and ulcerative colitis. 19 Endoscopic diagnosis of ulcerative colitis, Crohn's disease, Behçet's disease, and diverticular colitis is possible, based on their characteristic endoscopic abnormalities when the terminal ileum is observed by colonoscopy. However, isolated ileitis can be missed when the terminal ileum is not observed during a colonoscopic examination.…”

Section: Diagnosis Of Chronic Diarrhea: Endoscopic Examinationsmentioning

confidence: 99%

“…On the other hand, in the majority of cases, no endoscopically identifiable colonic mucosal lesions can be found. 19 , 22 In these patients, routine multiple biopsy sampling from different colonic segments including the terminal ileum without an apparent lesion is an important diagnostic process to be added. When multiple samples are obtained and properly processed, histopathological diagnosis is not difficult.…”

Section: Diagnosis Of Chronic Diarrhea: Endoscopic Examinationsmentioning

confidence: 99%

Endoscopic diagnosis of chronic diarrhea

et al. 2021

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The prevalence of chronic diarrhea in the general population is reported to be 4%–5%. Since various pathological conditions cause diarrheal symptoms, etiological diagnosis of chronic diarrhea is difficult in many cases. Medical history taking, physical examinations, and laboratory testing are not adequately sensitive or specific, thus a colonoscopic investigation is frequently employed for etiological evaluation. However, for cases with non‐bloody chronic diarrhea, the diagnostic yield of a colonoscopy procedure is reported to be not high enough. Furthermore, endoscopically identifiable findings are not adequately specific for the diagnosis of diarrheal disease, except for inflammatory bowel disease, while microscopic colitis, amyloidosis, eosinophilic gastroenteritis, celiac disease, and bile acid diarrhea are difficult to definitively diagnose using endoscopic findings. Thus, a histopathological examination of biopsy samples obtained with endoscopy is critically important. Endoscopists should consider obtaining biopsy samples from even normal‐appearing gastrointestinal mucosa for chronic diarrhea diagnosis.

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“…The routine ileal biopsy of normally appearing mucosa assessed by standard-resolution white-light ileoscopy is controversial because of the reported low diagnostic yield. 12 Currently, the position employed to intubate the ileum is with the patient in the left lateral position and entering the valve at the 6 o'clock position. However, we have sometimes encountered difficulty when performing ileoscopy in this position, leading to extra time being consumed during busy endoscopy lists.…”

Section: Introductionmentioning

confidence: 99%

The Value of Terminal Ileum Intubation During Colonoscopy

Al-Khalidi

Alrubaie

Rezqallah

et al. 2022

Journal of Coloproctology

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It is uncertain whether terminal ileum intubation should be performed routinely during colonoscopy, as there is uncertainty regarding its diagnostic value. The aim of the present study is to assess the diagnostic yield of terminal ileum intubation during colonoscopy according to indications for colonoscopy. This is a cross-sectional study in which the results of 294 total colonoscopy procedures were reviewed; ileal intubation was performed in 269 (91.49%) patients. The indications for colonoscopy, the results of ileoscopy, and the histopathological results of ileal biopsies were evaluated.A total of 54 (20%) out of 269 patients who had successful intubation into the terminal ileum showed macroscopic abnormalities on the terminal ileum. Biopsies were positive in 4 out of 54 (7.4%); all were of Crohn disease. Two were erosions (9.5%.) and 2 were ulcers (18.8%). The two erosions were presented as abdominal pain, abdominal pain and alternating bowel motion. Those with ulcers were presented with diarrhea and perianal disease. Conclusions Considering the low diagnostic yield of ileal intubation during colonoscopy, the decision to perform ileoscopy or not during colonoscopy needs to be made on a case-by-case basis. However, routine ileal intubation, brief attempts should be considered despite low diagnostic yield.

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Terminal ileum ileoscopy and histology in patients undergoing high‐definition colonoscopy with virtual chromoendoscopy for chronic nonbloody diarrhea: A prospective, multicenter study

Cited by 8 publications

References 36 publications

Inverse Association Between Helicobacter pylori Infection and Unexplained Isolated Terminal Ileitis: A Retrospective Study

Inverse Association Between Helicobacter pylori Infection and Unexplained Isolated Terminal Ileitis: A Retrospective Study

Endoscopic diagnosis of chronic diarrhea

The Value of Terminal Ileum Intubation During Colonoscopy

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