Routine ileoscopy at colonoscopy: a prospective evaluation of learning curve and skill-keeping line

Ileoscopy is the criterion standard for mucosal lesions of terminal ileum but is performed in 5% of colonoscopy activity, and the need for training is undefined.

To assess the learning curve and skill-keeping line of ileoscopy.

Prospective randomized study.

Single GI endoscopy unit.

Adult outpatients referred for colonoscopy.

Patient randomization to ileocolonoscopy by trainees and seniors.

Ileoscopy skill was divided into the following: ileocecal valve (ICV) intubation (success rate, time) and ileal exploration (length, time). Consecutive blocks of 10 procedures were used to calculate the learning curve and the skill-keeping line. Variables considered to influence ICV intubation were the following: endoscopist experience, ICV morphology, patient age, gender, body mass index, diverticular disease, and preceding abdominal/pelvic surgery.

Learning curve showed that competency in ICV intubation (80% success rate) and ileal exploration (16 cm) was achieved after 50 procedures. The skill-keeping line showed that ileoscopy was easy (97% success rate), fast (1 minute), and well accepted up to 45 cm of the ileum. Thin-lipped and volcanic ICV are the most difficult and easiest to intubate, respectively. Crohn's disease and adenomas of the proximal edge of ICV were diagnosed in 2.2%.

Training in ileoscopy is recommended to achieve competency, and endoscopists should consider practicing ICV intubation to maintain and increase their skill. Ileoscopy can be difficult when the ICV is thin lipped or single bulged, and easy when it has a volcanic morphology.