Ileoscopy; diagnostic yield in a tertiary care hospital of pakistan

ABSTRACT

Colonoscopy is one of the most important modalities to investigate complaints related to lower gastrointestinal tract. Terminal ileum is an essential part of the complete colonoscopic examination. Objectives: To observe the diagnostic yield of ileoscopy in patients undergoing colonoscopy. Design: Retrospective and observational study. Period January 2010 to May 2014. Setting: Liaquat National Hospital and Medical College. Patients and methods: Patients undergoing colonoscopy fulfilling inclusion and exclusion criteria were enrolled. Terminal ileum was examined and biopsies taken if abnormality present. Statistical analysis was done by SPSS- 18. Result: A total of 1296 patients were included, 884 [68.2%] were male and 412 [31.8%] were female. Age ranged from 15-90 years. The commonest indication was bleeding per rectum [35.6%].1133[87.4%] patients had normal mucosaand163 [12.6%] had abnormal mucosa on ileoscopy. Of these 163 patients, 68 had ulcers, 56 had inflammation, 29 had nodular mucosaand10 had polyp. Histopathological examination showed non-specific inflammation in 139 patients; granulomatous inflammation in 7; reactive lymphoid hyperplasia in 8; 3 had normal result; biopsies were not taken in remaining 6 patients. By using chi-square test we found a significant statistical relationship between macroscopic abnormality of terminal ileum mucosaandage of patients, weight loss, chronic diarrhoea, and abdominal pain. On logistic regression, age group, chronic diarrhoeaandweight loss retained strong relationship with macroscopic abnormality of terminal ileum mucosa. Conclusions: Though a large number of patients [12.6%] had abnormal terminal ileum mucosa, histopathological analysis did notshow any significant yield of ileoscopy. Terminal ileal abnormality was more common in young and middle aged patients and in patients presenting primarily with chronic diarrhoeaandweight loss.