Confirmation of complete colonoscopy without intubation of the ileum

To establish whether biopsy of the ileocaecal valve from the caecum provides an alternative to the more technically demanding procedure of terminal ileal intubation and biopsy to document completion of colonoscopy.

Fifty-three patients underwent colonoscopy at which the terminal ileum was intubated and biopsied and, after withdrawal of the endoscope tip into the caecum, the ileocaecal valve was then biopsied. To replicate the situation in which the ileum is not intubated, another group of 30 patients had ileocaecal valve biopsies taken from the caecum before ileal intubation was attempted.

All of the terminal ileal biopsies obtained before ileocaecal valve biopsy showed small bowel mucosa, as did 51 (96%) of the ileocaecal valve specimens from this group. When ileocaecal valve biopsy was obtained first, 16 (53%) specimens contained small bowel mucosa.

Ileocaecal valve biopsies were significantly more likely to yield small bowel mucosa if taken after ileal intubation (P < 0.001, Fisher's exact test). Nevertheless, about half of ileocaecal valve biopsies taken without ileal intubation contained small bowel mucosa, providing evidence of complete colonoscopy in these cases. Terminal ileal intubation and biopsy, however, remains the only reliable way to document complete colonoscopy.