Jeong Seong Hyun, Lee Kwang Jae, Kim Yeong Bae, Kwon Heok Chun, Sin Sung Jae, Chung Jae Yeon
Department of Gastroenterology, Ajou University Hospital, Suwon, South Korea.
J Gastroenterol Hepatol. 2008 Jan;23(1):51-5. doi: 10.1111/j.1440-1746.2007.05151.x.
Since the diagnostic value of ileoscopy is not well documented, it is uncertain if terminal ileum intubation should be performed routinely in patients undergoing colonoscopy. We aimed to assess the diagnostic yield of terminal ileum intubation during colonoscopy according to indications for colonoscopy.
We routinely performed terminal ileum intubation in subjects who underwent colonoscopy at Ajou University Hospital between 1 January 2005 and 31 December 2005. Demographic data, indications for colonoscopy, endoscopic, and histopathologic findings of the terminal ileum were assessed.
A total of 3921 subjects underwent colonoscopy. The terminal ileum was successfully intubated in 3417 cases (87.1%). Macroscopic abnormality on terminal ileum was present in 125 cases (3.7%), and biopsies were taken for all of them. Clinically significant histopathology was observed in 11 cases, giving a 0.3% diagnostic yield in all ileoscopies. Seven out of 11 cases were diagnosed as Crohn's disease. The rate of diagnostic yield was 1.8% in patients with right lower quadrant (RLQ) abdominal pain and 0.4% in patients with diarrhea. This rate in cases with RLQ pain was significantly greater compared with the indications for medical check-ups.
Terminal ileum intubation during colonoscopy identifies significant pathology in 1.8% of cases who have RLQ abdominal pain, suggesting diagnostic value in this setting. However, its diagnostic yield is very low in other indications for colonoscopy. Thus the decision to perform ileoscopy or not during colonoscopy needs to be made on a case-by-case basis.
由于回肠镜检查的诊断价值尚无充分文献记载，因此对于接受结肠镜检查的患者是否应常规进行末段回肠插管尚不确定。我们旨在根据结肠镜检查的适应证评估结肠镜检查时末段回肠插管的诊断率。
2005年1月1日至2005年12月31日期间，在阿朱大学医院对接受结肠镜检查的患者常规进行末段回肠插管。评估了人口统计学数据、结肠镜检查的适应证、末段回肠的内镜及组织病理学检查结果。
共有3921例患者接受了结肠镜检查。3417例（87.1%）成功完成末段回肠插管。末段回肠存在肉眼可见异常的有125例（3.7%），均进行了活检。观察到具有临床意义的组织病理学改变的有11例，在所有回肠镜检查中的诊断率为0.3%。11例中有7例被诊断为克罗恩病。右下腹痛患者的诊断率为1.8%，腹泻患者的诊断率为0.4%。与体检适应证相比，右下腹痛患者的这一诊断率显著更高。
结肠镜检查时末段回肠插管在1.8%的右下腹痛患者中发现了有意义的病变，提示在此情况下具有诊断价值。然而，在结肠镜检查的其他适应证中其诊断率非常低。因此，结肠镜检查时是否进行回肠镜检查需要根据具体情况决定。
