Usefulness of Routine Terminal Ileoscopy and Biopsy during Colonoscopy in a Tropical Setting: A Retrospective Record-Based Study

Introduction. Available evidence for routine terminal ileoscopy during colonoscopy is equivocal. We investigated the place of routine terminal ileoscopy and biopsy during colonoscopy, in a tropical setting. Materials and Methods. All consenting adults undergoing colonoscopy had routine TI and biopsy. Patients with right iliac fossa (RIF) pain, diarrhoea, anaemia, suspected inflammatory bowel disease (IBD), and raised inflammatory markers were defined as Group A and all others undergoing colonoscopy as Group B. Results. Caecal intubation and TI were achieved in 988/1096 (90.15%) and 832/1096 (75.9%) cases, respectively. 764/832(91.8%) patients were included in final analysis. 81/764 (10.6%) patients had either macroscopic (34/81) or microscopic (47/81) abnormalities of terminal ileum; 20/81 had both. These were CD (28/47), tuberculosis (TB) (6/47), ileitis due to resolving infection (8/47), and drug-induced ileitis (5/47). 27/81 with macroscopically normal ileum had CD (18/27), ileitis due to resolving infection (5/27) and drug-induced ileitis (4/27) on histology. 12/764 (1.57%) patients with macroscopically normal colon had ileal CD (8/12), drug-induced ileitis (2/12), and resolving ileal infection (2/12) on histology. 47/764 (6.15%) patients had ileal pathology that influenced subsequent management. These were significantly higher in Group A (43/555 (8%)) than in Group B (4/209 (1.9%)) ( , ). Conclusion. TI and biopsy improve diagnostic yield of colonoscopy in patients with RIF pain, diarrhoea, anaemia, suspected IBD, and raised inflammatory markers. 1. Introduction Terminal ileoscopy (TI) is an integral part of colonoscopy [1]. It confirms completion of colonoscopy. Studies have shown that TI adds only three minutes to colonoscopy procedure time [2]. Furthermore there are no complications in addition to those of colonoscopy [3]. The available evidence for routine TI and biopsy during colonoscopy is equivocal. Some studies have demonstrated a benefit of TI and biopsy in selected patients. These include patients with diarrhoea, right lower quadrant pain, hematochezia, suspected inflammatory bowel disease (IBD), and ileocaecal tuberculosis (TB) [1, 3–6]. Most studies of routine TI during colonoscopy have been performed in Western populations. Only a few studies have been conducted in Asian or other tropical regions [3, 5]. These regions have a different spectrum of gastrointestinal diseases—a relatively low prevalence of Crohn’s disease (CD) and higher prevalence of gastrointestinal infections, including TB [5, 7]. Therefore, we investigated the place of