Jb. Marshall et Js. Barthel, THE FREQUENCY OF TOTAL COLONOSCOPY AND TERMINAL ILEAL INTUBATION IN THE 1990S, Gastrointestinal endoscopy, 39(4), 1993, pp. 518-520
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.