Endoscopy 2019; 51(04): S29
DOI: 10.1055/s-0039-1681254
ESGE Days 2019 oral presentations
Friday, April 5, 2019 11:00 – 13:00: Capsule – enteroscopy Club B
Georg Thieme Verlag KG Stuttgart · New York

TERMINAL ILEUM ILEOSCOPY AND HISTOLOGY IN PATIENTS UNDERGOING HIGH-DEFINITION COLONOSCOPY WITH VIRTUAL CHROMO-ENDOSCOPY FOR CHRONIC NON-BLOODY DIARRHEA: A PROSPECTIVE MULTI-CENTER STUDY

E Borsotti
1   San Donato Hospital, San Donato Milanese, Italy
,
B Barberio
2   University of Padua, Padua, Italy
,
R D'Incà
2   University of Padua, Padua, Italy
,
G Bonitta
1   San Donato Hospital, San Donato Milanese, Italy
,
F Cavallaro
1   San Donato Hospital, San Donato Milanese, Italy
,
L Pastorelli
1   San Donato Hospital, San Donato Milanese, Italy
,
E Rondonotti
3   Ospedale Valduce, Como, Italy
,
L Samperi
4   Ospedale Morgagni Pierantoni, Forlì, Italy
,
H Neumann
5   Department of Interdisciplinary Endoscopy, 1st Medical Clinic and Polyclinic, University Hospital Mainz, Mainz, Germany
,
C Viganò
6   San Gerardo Hospital, Monza, Italy
,
M Vecchi
7   IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milano, Italy
,
GE Tontini
7   IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milano, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 
 

    Aims:

    Ileo-colonoscopy is the procedure of choice for chronic non-bloody diarrhea (CNBD) of unknown origin. The histological evaluation at different colonic sites is mandatory to assess the presence of microscopic colitis. However, the value of routine ileal biopsy on normal-appearing mucosa as assessed with standard-resolution white-light ileoscopy is controversial given its reported low diagnostic yield. Hence, we have assessed for the first time the accuracy of retrograde ileoscopy using high-definition and dye-less chromo-endoscopy (HD+DLC), thereby calculating the impact and cost of routine ileal biopsy in CNBD.

    Tab. 1:

    Statistical measures of the performance of retrograde ileoscopy with HD plus virtual chromo-endoscopy using histopathology as the gold standard

    Test

    Value

    Sensitivity

    0.933 (0.660 – 0.996)

    Specificity

    0.983 (0.966 – 0.992)

    Positive Likelihood ratio

    55.6 (27.6 – 112.1)

    Negative Likelihood ratio

    0.068 (0.010 – 0.450)

    Methods:

    Patients with CNBD of unknown origin were prospectively enrolled for ileo-colonoscopy with HD+DLC in 5 referral centers. Multiple biopsies were systematically performed in each colo-rectal segment and terminal ileum for histo-pathological analysis.

    Results:

    Between 2014 and 2017, 546 consecutive patients were recruited. Retrograde ileoscopy success rate was 97.6%. 492 patients (mean age: 53 ± 18 years) fulfilled all the inclusion criteria: following endoscopic and histo-pathological work-up, 7% had lymphoid nodular hyperplasia and 3% had isolated ileitis. Compared to the histo-pathology as the gold standard, retrograde ileoscopy with HD+DLC showed 93% sensitivity, 98% specificity and 99.8% negative predictive value. In patients with normal ileo-colonoscopy, ileum histology had no diagnostic gain and came with a US$ 26.5 cost per patient.

    Conclusions:

    Retrograde ileoscopy with HD+DLC predicts the presence of ileitis in CNBD with excellent performance. The histo-pathological evaluation of the terminal ileum is the gold standard for the diagnostic assessment of visible lesions but has no added diagnostic value in CNBD patients with negative ileo-colonoscopy inspection using modern endoscopic imaging techniques.


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