Comparison of Colonoscopy and Histopathological Findings in Terminal Ileum Lesions

Yıl 2024, Cilt: 11 Sayı: 2, 220 - 223, 28.06.2024

Elif Tuğba Tuncel , Selçuk Turgut , Tahir Buran , Elmas Kasap

https://doi.org/10.34087/cbusbed.1373562

Öz

Öz
Giriş ve Amaç
Terminal ileumu etkileyen hastalıklarda kolonoskopi ile terminal ileumun görüntülenmesi ve biyopsi alınması altın standarttır. Bu çalışmada kolonoskopik görünüm ile terminal ileumun histopatolojik bulgularının tanısal açıdan karşılaştırılması amaçlandı.
Gereç ve Yöntemler
2014-2023 yılları arasında Celal Bayar Üniversitesi Tıp Fakültesi Gastroenteroloji kliniğinde kolonoskopi yapılan 971 hasta dosyası retrospektif incelenerek veriler toplandı. Hastaların yaş ve cinsiyet gibi demografik verileri kaydedildi. Kolonoskopi raporları ve histopatolojik bulguları değerlendirildi.
Sonuçlar
Hastaların 457’si (%47 ) kadın, 514’ü (%53) erkekti. Yaş ortalaması 47,7’di. Hem kolonoskopik hem de histopatolojik olarak terminal ileumu normal olan hasta sayısı 562(%57,8)’di. Terminal ileumda hem kolonoskopik hem de histopatolojik olarak en fazla görülen bulgu mukozal ödemdi (%6,1). Kolonoskopide normal terminal ileumu olanlarda histopatolojik olarak ileit saptanma oranı 27(%4) ve ileal ülser olanlarda patolojik olarak kronik inflamatuar barsak hastalığı saptanma oranı ise 28(%49,1)’di.
Tartışma
Kolonoskopik görünüm ile histopatolojik bulguların anlamlı oranda korele olduğu gösterildi. Bundan dolayı ileal hastalıkların tanısında hem kolonoskopik görünüm hem de histopatolojik bulgular aynı oranda değerlidir. Ayrıca klinik olarak gerekli durumlarda ileum entübasyonu ve histopatolojik değerlendirme mutlaka yapılmalıdır.

Anahtar Kelimeler

kolonoskopi, histopatoloji, ileum, tanı değeri

Comparison of Colonoscopy and Histopathological Findings in Terminal Ileum Lesions

Öz

Abstract
Objective
In diseases affecting the terminal ileum, the gold standard approach is to image the terminal ileum using colonoscopy and take a biopsy sample. This study aimed to compare the colonoscopic appearance and histopathological findings of the terminal ileum from a diagnostic perspective.
Materials and Methods
Data were retrospectively collected by screening the files of 971 patients who underwent colonoscopy at the gastroenterology clinic of Celal Bayar University Faculty of Medicine between January 2014 and July 2023. The patients’ demographic data, such as age and gender, were recorded. Colonoscopy reports and histopathological findings were evaluated.
Results
Of the patients, 457 (47%) were women, and 514 (53%) were men. The mean age was 47.7 years. The number of patients with a normal terminal ileum, both colonoscopically and histopathologically, was 562 (57.8%). The most common finding in the terminal ileum, both colonoscopically and histopathologically, was edematous mucosa 6.1%. The rate of histopathological ileitis detection in patients with a normal terminal ileum on colonoscopy was 4% (27), and the rate of the pathological detection of chronic inflammatory bowel disease in those with an ileal ulcer was 49.1% (28).
Conclusion
The results of this study showed that the colonoscopic appearance and histopathological findings of terminal ileum lesions were significantly correlated; therefore, both are equally valuable in the diagnosis of ileal diseases. Additionally, ileum intubation and histopathological evaluation must be performed when clinically necessary.

Anahtar Kelimeler

colonoscopy, histopathology, ileum, diagnostic value

Etik Beyan

The study was conducted in accor¬dance with the principles of the Declaration of Helsinki, and the study protocol was approved by the Health Sciences Ethics Committee of Celal Bayar University Medical School (date: 31/08/2023; number: 2021/20.478.486/1963).

Kaynakça

• 1. Lee SH, Chung II, Kim SJ, Kim JO, et al. An adequate level of training for technical competence in screening and diagnostic colonoscopy: a prospective multicenter evaluation of learning curve. Gastrointest Endosc 2008;67:683-89.
• 2. Mc Hugh JB, Appelman HD, McKenna BJ. The diagnostic value of endoscopic terminal ileum biopsies. Am J Gastroenterol. 2007; 102: 1084-9.
• 3. Jeong SH, Lee KJ, Kim YB, Kwon HC, Sin SJ, Chung JY. Diagnostic value of terminal ileum intubation during colonoscopy. J Gastroenterol Hepatol. 2008; 23: 51-5.
• 4. Rey JF, Lambert R. ESGE Quality Assurance Committee. ESGE recommendations for quality control in gastrointestinal endoscopy: guidelines for image documentation in upper and lower GI endoscopy. Endoscopy 2001;33:901-3.
• 5. Rex DK, Petrini JL, Baron TH, et al. Quality indicators for colonoscopy. Gastrointest Endosc 2006;63:S16-28.
• 6. da Silva JG, De Brito T, Cintra Damião AO, Laudanna AA, Sipahi AM. Histologic study of colonic mucosa in patients with chronic diarrhea and normal colonoscopic findings. J Clin Gastroenterol 2006; 40: 44–8.
• 7. Shah RJ, Fenoglio-Preiser C, Bleau BL, Giannella RA. Usefulness of colonoscopy with biopsy in the evaluation of patients with chronic diarrhea. Am J Gastroenterol 2001; 96: 1091–5.
• 8. Schusselé Filliettaz S, Juillerat P, Burnand B et al.; EPAGE II Study Group. Appropriateness of colonoscopy in Europe (EPAGE II). Chronic diarrhea and known inflammatory bowel disease. Endoscopy 2009; 41: 218–26.
• 9. Cuvelier C, Demetter P, Mielants H, Veys EM, De Vos M. Interpretation of ileal biopsies: morphological features in normal and diseased mucosa. Histopathology. 2001; 38: 1-12.
• 10. Powell N, Hayee BH, Yeoh DP, Rowbotham DS, Saxena V, Mc Nair A. Terminal ileal photography or biopsy to verify total colonoscopy: does the endoscope agree with the microscope? Gastrointest Endosc. 2007; 66: 320-5.
• 11. Yoong KK, Heymann T. It is not worthwhile to perform ileoscopy on all patients. Surg Endosc. 2006; 20: 809-11.
• 12. Cherian S, Singh P. Is routine ileoscopy useful? An observational study of procedure times, diagnostic yield, and learning curve. Am. J. Gastroenterol. 2004; 99: 2324–9.
• 13. Melton SD, Feagins LA, Saboorian MH, Genta RM. Ileal biopsy: clinical indications, endoscopic and histopathologic findings in 10,000 patients. Dig Liver Dis. 2011; 43: 199-203.
• 14. Sayilir A, Kurt M, Kekilli M, Onal IK, Beyazit Y, Turhan N, et al. Diagnostic value of terminal ileum biopsy in chronic diarrhea with normal endoscopic appearance. J Dig Dis. 2011; 12: 188-92.
• 15. Melo MM, Cury PM, Ronchi LS, Gonc alves-Filho Fde A, Cunrath GS, Netinho JG. Terminal ileum of patients who underwent colonoscopy: endoscopic, histologic and clinical aspects. Arq Gastroenterol. 2009; 46: 102-6.
• 16. Koksal AR, Boga S, Alkim H, Ergun M, Bayram M, Sakiz D, Ozdogan O, Altinkaya E, Alkim C, How does a biopsy of endoscopically normal terminal ileum contribute to the diagnosis? Which patients should undergo biopsy? Libyan J Med, 2014, 9: 23441