L'ileoscopia retrograda: Fattibilita come esame routinario e utilita diagnostica

A prospective study was undertaken to evaluate the feasibility and the usefulness of retrograde ileoscopy during total colonoscopy. In a first group of 548 consecutive diagnostic colonescopies, the ciecum was visualized in 538 (98.1%) cases and the terminal ileum in 502 (91.6%); in 70 patients suspected of ileal diseases the success rate of ileoscopy was 95.8%. Biopsies were performed in presence of macroscopic abnormality of the mucosa; the incidence of macroscopic and histologic lesions was respectively 2% and 0.4% in asymptomatic patients, 24.3% and 20% in the selected patients. After this series, other selective criteria were applied and 51 patients suspected of inflammatory or malignant intestinal disease were submitted to ileoscopy: in this group the incidence of macroscopic and histologic ileal lesions was 19.6% and 15.7%, with a malignancy rate of 4.1%. We had no complications in the 553 ileoscopies; painful exams rate was 0.3%. In our experience, retrograde ileoscopy can be a useful extension of colonoscopy when colonic examination is negative in symptomatic patients or, when positive, ileal associated lesions should be suspected; it may be the first elective exam in suspected ileal disease.