ILEOSCOPY: WHEN ILEAL EVALUATION IS NOT MANDATORY DURING COLONOSCOPY

Ileitis is defined as ileal inflammation, with several etiologies, including inflammatory bowel disease (IBD), and can be evaluated during the colonoscopy exam, but its mandatory evaluation is discussed, because of few diagnosis and procedure time.

OBJECTIVE:

This study aims to evaluate the correlation of colonoscopic ileitis with the clinical presentation, in order to identify the cases where ileal examination is mandatory.

METHODS:

A retrospective, cross-sectional study was conducted between 2013 and 2017. The examination report, indications for colonoscopy, and medical records were evaluated in order to identify whether the colonoscopic findings were clinically significant. Patients over 18 years of age who had undergone ileoscopy were included, whereas patients below 18 years of age, those with previous intestinal resections, and repeated examinations of the same patient in the study period were excluded. The estimated association measure was the odds ratio with 95% confidence intervals. P-values <0.05 indicated statistical significance.

RESULTS:

A total of 3382 cases were included. Among these participants, 64.5% were females and the average age was 56.9±13.1 years (18-89 years). Ileal alterations were observed in 5.3% of the patients, with 2.69% being clinically significant between all patients, and 0.96% excluding those with IBD. There was a positive correlation between the ileitis findings and IBD control examinations and a negative correlation in screening and change in bowel habit indications. Among the indications with ileitis clinically significant, IBD control still had a positive correlation, ‘diarrhea’ and ‘others’ did not show a statistical significance, and all other indications presented a negative correlation for ileal assessment.

CONCLUSION:

Ileal evaluation in only mandatory in IBD control. When the main colonoscopy objective is detecting colonic neoplasms, ileoscopy is unnecessary.

Keywords:
Colonoscopy; ileitis; inflammatory bowel disease; cancer screening; colonic polyp

Indication	n	With endoscopic ileitis	Endoscopic clinical relevant ileitis	P	OR (95% CI)
Abdominal pain	486	21 (4.3)		0.302	0.78 (0.49-1.25)
			5 (1)	0.019	0.34 (0.14-0.84)

Bleeding	706	27 (3.8)		0.052	0.66 (0.43-1.00)
			9 (1.3)	0.012	0.41 (0.20-0.82)

Anemia	278	13 (4.7)		0.632	0.86 (0.49-1.55)
			1 (0.4)	0.037	0.12 (0.02-0.88)

Constipation	144	3 (2.1)		0.091	0.37 (0.12-1.17)
			0 (0)	0.041	-

Diarrhea	421	27 (6.4)		0.273	1.27 (0.83-1.93)
			15 (3.6)	0.233	1.41 (0.80-2.47)

Weight loss	420	14 (3.3)		0.058	0.58 (0.34-1.02)
			3 (0.7)	0.014	0.24 (0.07-0.75)

Cancer control	29	1 (3.5)		0.659	0.64 (0.09-4.71)
			0 (0)	0.008	-

Polyp control	302	12 (4)		0.258	0.72 (0.40-1.31)
			1 (0.3)	0.028	0.11 (0.02-0.79)

Change in bowel habit	246	4 (1.6)		0.012	0.28 (0.10-0.76)
			0 (0)	0.007	-

Control of IBD	273	61 (22.3)		<0.001	7.29 (5.20-10.2)
			61 (22.3)	<0.001	29.3 (18.5-46.4)

Screening	638	12 (1.9)		<0.001	0.30 (0.16-0.53)
			2 (0.3)	0.001	0.09 (0.02-0.38)

Others	192	12 (6.3)		0.542	1.21 (0.66-2.21)
			2 (1.1)	0.163	0.37 (0.09-1.50)

Lesion	n
None	3203
Erosion	42
Ulcer	40
Lymphoid hyperplasia	29
Others	17
Enanthema	11
Erosion and enanthema	8
Polyp	6
Ulcer and other	4
Ulcer and erosion	4
Ulcer and enanthema	3
Erosion, polyps, and others	3
Erosion and others	3
Enanthema and others	2
Ulcer, enanthema, and others	2
Ulcer and lymphoid hyperplasia	1
Lymphoid hyperplasia and polyps	1
Ulcer and polyp	1
Lymphoid hyperplasia, erosion, and enanthema	1
Ulcer, erosion, enanthema, and others	1
Total	3382

Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia e Outras Especialidades - IBEPEGE. Rua Dr. Seng, 320, 01331-020 São Paulo - SP Brasil, Tel./Fax: +55 11 3147-6227 - São Paulo - SP - Brazil
E-mail: secretariaarqgastr@hospitaligesp.com.br

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[1] Corresponding author: Leticia Rosevics. E-mail: le.rosevics@yahoo.com.br