Routine examination of the terminal ileum, is it necessary?

AIM: The aim of this study was to determine the diagnostic yield of routine examination of the terminal ileum during colonoscopy. METHOD: We retrospectively reviewed the reports of 1380 consecutive colonoscopies performed in our unit over a period of seven years RESULT: The age range of the patients was 16-95 years The terminal ileum was intubated in 424 patients. The gross appearance was abnormal in 9 cases (2.1%). The macroscopic findings included ulcers, erythema, nodules and polyp in one case. Histology revealed evidence of a carcinoid in 1 case, inflammatory bowel diseases in 3 patients and CMV ileitis in 1 patient. Two patients had non-specific inflammation while in 2 others the biopsy showed lymphoid hyperplasia. Of the 5 patients with significant findings, in only one (0.2%) was the finding unexpected. In the remaining 4 patients, disease of the terminal ileum had been suspected prior to the procedure CONCLUSION: Routine examination of the terminal ileum does not appear to be useful. It is probably necessary only when a specific pathology of the terminal ileum is suspected.