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DOI: 10.1055/s-0039-1681254
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
Publikationsverlauf
Publikationsdatum:
18. März 2019 (online)
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.
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.