THE FREQUENCY OF TOTAL COLONOSCOPY AND TERMINAL ILEAL INTUBATION IN THE 1990S

We examined the frequency of total colonoscopy and terminal ileal intu bation in a training setting using modern videoendoscopic equipment an d techniques with examinations supervised or done by the two authors. The cecum was considered reached if the endoscopic report included a d escription of the cecal landmarks visualized and if electronic images documenting these landmarks were obtained. One of us also routinely at tempted terminal ileal intubation for documentation purposes, allottin g a minute or two for the purpose. In cases of chronic diarrhea and po ssible inflammatory bowel disease, a more prolonged attempt was made t o visualize the terminal ileum. Among 418 consecutive colonoscopies, t he cecum was reached in 96% of cases. If cases of malignant obstructio n were excluded, the success rate improved to 97%. When routinely atte mpted, the terminal ileum was intubated and inspected in 74% of cases (excluding cases of malignant obstruction). In cases in which terminal ileal intubation and inspection was deemed necessary, the success rat e was 91%. We conclude that total colonoscopy can be accomplished in t he 1990s in excess of 90% of cases and can be documented by high-quali ty photographs that can be attached to the procedure report. High rate s of successful total colonoscopy should be attainable even in trainin g programs. Routine intubation of the terminal ileum can be performed to provide further objective proof of the extent of colonoscopy and to allow the endoscopist to develop and maintain the skill. A skilled, p racticed endoscopist can inspect the terminal ileum in about 90% of ca ses in which such examination is needed.