A prospective study of the technical feasibility of ileoscopy at colonoscopy

Despite a well-documented diagnostic yield, ileoscopy at colonoscopy is not performed routinely. This is due to the perceived difficulty in intubating the ileocaecal valve, added procedure time and a lack of acceptance regarding diagnostic yield. Therefore, we conducted a study to investigate the technical feasibility of ileoscopy at colonoscopy.

Ileoscopy was studied prospectively in 120 patients undergoing diagnostic colonoscopy. After identification of the caecum, ileoscopy was attempted by one of four techniques. The time taken to pass from caecum to terminal ileum, the patient position, use of Hyoscine-n-butyl bromide and any ileal abnormalities were recorded in each case.

Ileoscopy was successful in 117/120 (97%) cases with a median time of 55 s taken to intubate the ileo-caecal valve. A 'down and left' technique was used in most cases (74.4%). Switching the patient to supine aided ileoscopy in 24 cases (20.4%) and Hyoscine-n-butyl bromide was considered helpful in 25 (21.4%). Overall, the terminal ileum was abnormal in 24 of 117 (20.5%) patients.

Ileoscopy can be achieved in nearly all patients undergoing diagnostic colonoscopy and the added procedure time is short. Added time, technical difficulty and limited yield are not valid reasons for choosing not to perform ileoscopy.