Introduction Terminal ileal (TI) images are reliable indicators of completeness of colonoscopy¹. Studies have shown that TI image provide more convincing than caecal images to verify completion of colonoscopy². Acquisitionof TI images after water insufflation (WI) has been found to produce reliable images³.We wanted to identify if TI images after WI through the biopsy channel or narrow band images of TI produce more reliable as part of image documentation.

Methods 4 images of terminal ileum were captured using Olympus colonoscope ®. They were 1 captured with conventional white light endoscopy (WLE), 1 captured with white light endoscopy + water insufflation (WLEWI), 1 captured with narrow band imaging (NBI) and 1 captured with NBI + water insufflation (NBIWI).

Without informing that these were TI images, the 4 terminal images were sent to endoscopists by email along with an invitation to participate in a survey using survey monkey® portal. Using the survey the respondents marked each image as follows: not terminal ileum = 1, may be terminal ileum = 2, most likely terminal ileum = 3, definitely terminal ileum = 4.

Results 36 endoscopists completed our survey. 49% were gastroenterology Specialist registrar, 40% were consultant gastroenterologists and 11% were colorectal surgeons. Most of the respondents (n = 31) were from the UK, 4 were from the United States and 1 was from the rest of the Europe.

19.4% (n = 7) of respondents had colonoscopy experience of 1–2 years, 30.6% (n = 11) had colonoscopy experience of 3–5 years, 19.4% (n = 7) had colonoscopy experience of 5–9 years 30.6% (n = 11) had colonoscopy experience of more than 10 years.

Responses in Table 1:

Conclusion Water insufflation on terminal ileum using the biopsy channel of colonoscope produce more reliable images compared to White light or narrow band images (NBI). Combination of NBI and water insufflation together produced the most reliable images.

Disclosure of Interest None Declared.

References

1. Cherian S, Singh P. Is routine ileoscopy useful? An observational study of procedure times, diagnostic yield, and learning curve. Am J Gastroenterol 2004; 99(12):2324–2329.

2. Powell N, Knight H, Dunn J, Saxena V, Mawdsley J, Murray C et al. Images of the terminal ileum are more convincing than cecal images for verifying the extent of colonoscopy. Endoscopy 2011; 43(3):196–201.

3. Baraza W, Brown S, Shorthouse AJ, Tiffin N, Hurlstone DP. Direct photographic documentation of ileal mucosa in routine colonoscopy is not an independent valid or reliable proof of completion: quality assurance issues for the national colorectal cancer-screening programme. Colorectal Dis 2009; 11(1):89–93.