Clinical Associations between the Supplementary Examinations of the Terminal Ileal Mucosal Lesion and the Lesion of the Ileocecal Valve

ABSTRACT

BACKGROUND/AIMS: The diagnostic value of terminal ileum (TI) biopsies during colonoscopy remains controversial. This study assessed the clinical characteristics of terminal ileal lesions during colonoscopy to find the affecting factors for the specific investigations in addition to TI biopsies. METHODS: Thirty-seven patients (male to female ratio of 1.6, mean age 42.2+/-12.2 years, range 20-68 years) who had undergone colonoscopy with biopsies of TI at Dongguk University International Hospital from September 2005 to December 2007 were retrospectively studied. We analyzed the characteristics of patients, endoscopic and histopathologic findings, followed by multivariate analysis of those significant variables. RESULTS: Ulcerative lesions were most frequently found in 17 cases (45.9%) and multiple lesions were observed in eight cases (21.6%). Aphthoid shape was evident in 19 cases (51.4%). Eight cases (21.6%) were combined with ileocecal valve (ICV) lesion. On histopathologic examination, nonspecific inflammation was evident in 19 cases (51.4%). The diagnostic yield of TI biopsies was 5.4%. Presence of ICV lesion (p=0.004) and multiple lesions (p=0.027) were associated with clinically significant TI lesion. By multivariate analysis, only ICV lesion was statistically significant (Odds ratio 8.3 95% confidence interval 1.3-54.1, p=0.026). CONCLUSIONS: Not all patients who undergo colonoscopy require intubation of TI. However, a careful examination of ICV could be useful to determine whether intubation of TI would be necessary or not.