Routine terminal ileum intubation and biopsy: A standard practice for colonoscopy completion
Background and Objectives:
Colonoscopy is a crucial diagnostic tool, and terminal ileum intubation (TII) is its final step, typically used to examine the ileum. While TII can provide valuable insights through histological analysis of the ileal mucosa, there's no universal agreement on when to perform it. This systematic review aims to assess the routine practice of TII and biopsy during colonoscopy.
Methods:
The study searched PubMed, EMBASE, Cochrane Library, and Science Citation Index via Web of Science from January 1, 1971, to October 1, 2025. It included studies focusing on TII and biopsy during colonoscopy, excluding case reports, letters, reviews, and animal studies. The primary outcomes were the diagnostic yield of TII and the rate of management changes. Three reviewers independently extracted the data.
Results:
Thirty-six studies were analyzed. The diagnostic yield and management change rates were significantly higher in selected patients compared to unselected ones (5.1% vs. 2.5% and 1.5% vs. 0.4%, respectively). Inflammatory bowel disease, anemia, abdominal pain, and chronic diarrhea showed higher diagnostic yields (26.7%, 16.1%, 14.9%, and 12.4%, respectively). Interestingly, the yield of ileal histopathology with normal endoscopic findings was low in both groups (3.5% and 2.4%).
Conclusions:
TII is the gold standard for completing colonoscopy, playing a vital role in diagnosis. We recommend adopting TII as a standard practice, with photo documentation for all patients. Biopsy is advised for abnormal mucosal findings or red-flag symptoms like diarrhea, suspected IBD, abdominal pain, or anemia. This study invites further discussion on the optimal use of TII and biopsy in colonoscopy practice.
Controversy and Comment Hooks:
The study's findings suggest that TII and biopsy are more effective in selected patients, raising questions about the routine practice. Some may argue that the low yield of ileal histopathology with normal endoscopic findings justifies avoiding TII in all cases. Others might suggest that the benefits outweigh the risks, especially for patients with red-flag symptoms. What do you think? Do you agree or disagree with the study's recommendations? Share your thoughts in the comments!
