From the Guidelines
Ileoscopy is recommended during colonoscopy to evaluate the terminal ileum for conditions such as inflammatory bowel disease (particularly Crohn's disease), unexplained gastrointestinal bleeding, chronic diarrhea, suspected malignancy, or when abnormalities are seen on imaging studies. The procedure is performed as an extension of a standard colonoscopy by advancing the colonoscope through the ileocecal valve into the terminal ileum. After reaching the cecum, the endoscopist identifies the ileocecal valve, which typically appears as a lip-like structure on the medial wall of the cecum. The colonoscope is then maneuvered to align with the valve, and gentle pressure with water irrigation helps to intubate the terminal ileum. Usually, 5-20 cm of the terminal ileum is examined, though deeper insertion may be performed if necessary. Biopsies can be taken during the procedure if abnormalities are found. Patients require the same preparation as for a standard colonoscopy, including bowel cleansing with solutions like polyethylene glycol.
Indications for Ileoscopy
- Inflammatory bowel disease (particularly Crohn's disease)
- Unexplained gastrointestinal bleeding
- Chronic diarrhea
- Suspected malignancy
- Abnormalities seen on imaging studies
Procedure
- Advance the colonoscope through the ileocecal valve into the terminal ileum
- Identify the ileocecal valve, which typically appears as a lip-like structure on the medial wall of the cecum
- Maneuver the colonoscope to align with the valve, and use gentle pressure with water irrigation to intubate the terminal ileum
- Examine 5-20 cm of the terminal ileum, with deeper insertion if necessary
- Take biopsies if abnormalities are found
Preparation
- Same preparation as for a standard colonoscopy
- Bowel cleansing with solutions like polyethylene glycol
Ileoscopy is valuable because the terminal ileum is a common location for Crohn's disease lesions and can reveal pathology not visible by other means, providing crucial diagnostic information that may alter patient management, as supported by the British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults 1. Additionally, a study published in the Journal of Crohn's and Colitis found that ileoscopy with biopsy histology is superior in establishing the diagnosis of mild ileal Crohn’s disease 1.
From the Research
Ileoscopy Procedure and Recommendations
- Ileoscopy is a procedure that involves the examination of the ileum, which is the last part of the small intestine, using an endoscope 2, 3, 4, 5.
- The procedure is typically performed during a colonoscopy, where the doctor attempts to intubate the terminal ileum to visualize the ileum and detect any abnormalities 2, 3, 4, 5.
Indications for Ileoscopy
- Ileoscopy is recommended in patients with suspected Crohn's disease, as it can help identify inflammation and other abnormalities in the ileum 2, 4, 6.
- It is also recommended in patients with unexplained lower gastrointestinal bleeding, as it can help detect bleeding sources in the ileum 3, 5.
- Ileoscopy may be performed in patients with other small bowel disorders, such as celiac disease or intestinal lymphoma 3, 4.
Performance of Ileoscopy
- Ileoscopy is typically performed using a colonoscope, which is inserted through the rectum and guided to the ileum 2, 3, 4, 5.
- The procedure may be performed with or without sedation, depending on the patient's preference and medical history 2, 3, 4, 5.
- The doctor will visualize the ileum and take biopsies or perform other interventions as needed 2, 3, 4, 5.
Comparison with Other Diagnostic Techniques
- Ileoscopy has been compared to other diagnostic techniques, such as capsule endoscopy, CT enterography, and small-bowel follow-through, in the diagnosis of Crohn's disease and other small bowel disorders 2, 4, 6.
- Studies have shown that ileoscopy can be a useful diagnostic tool, particularly in patients with suspected Crohn's disease or unexplained lower gastrointestinal bleeding 2, 4, 6.
- However, ileoscopy may not be as sensitive as other diagnostic techniques, such as capsule endoscopy, in detecting small bowel lesions or inflammation 4, 6.