title: Routine ileoscopy at colonoscopy: a prospective evaluation of learning curve and skill-keeping line.
abstract: BACKGROUND
  Ileoscopy is the criterion standard for mucosal lesions of terminal ileum but is performed in 5% of colonoscopy activity, and the need for training is undefined.
  
  
  OBJECTIVE
  To assess the learning curve and skill-keeping line of ileoscopy.
  
  
  METHODS
  Prospective randomized study.
  
  
  METHODS
  Single GI endoscopy unit.
  
  
  METHODS
  Adult outpatients referred for colonoscopy.
  
  
  METHODS
  Patient randomization to ileocolonoscopy by trainees and seniors.
  
  
  METHODS
  Ileoscopy skill was divided into the following: ileocecal valve (ICV) intubation (success rate, time) and ileal exploration (length, time). Consecutive blocks of 10 procedures were used to calculate the learning curve and the skill-keeping line. Variables considered to influence ICV intubation were the following: endoscopist experience, ICV morphology, patient age, gender, body mass index, diverticular disease, and preceding abdominal/pelvic surgery.
  
  
  RESULTS
  Learning curve showed that competency in ICV intubation (80% success rate) and ileal exploration (16 cm) was achieved after 50 procedures. The skill-keeping line showed that ileoscopy was easy (97% success rate), fast (1 minute), and well accepted up to 45 cm of the ileum. Thin-lipped and volcanic ICV are the most difficult and easiest to intubate, respectively. Crohn's disease and adenomas of the proximal edge of ICV were diagnosed in 2.2%.
  
  
  CONCLUSIONS
  Training in ileoscopy is recommended to achieve competency, and endoscopists should consider practicing ICV intubation to maintain and increase their skill. Ileoscopy can be difficult when the ICV is thin lipped or single bulged, and easy when it has a volcanic morphology.
authors.affiliation: U.O.C. di Gastroenterologia ed Endoscopia Digestiva, Ospedale San Giovanni-Addolorata-Calvary, Istituto Superiore di Sanità, Roma, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Iacopini
authors.forename: Stefano
authors.initials: S
authors.lastname: Frontespezi
authors.forename: Mario Alessandro
authors.initials: MA
authors.lastname: Vitale
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Villotti
authors.forename: Antonino
authors.initials: A
authors.lastname: Bella
authors.forename: Lucia
authors.initials: L
authors.lastname: d'Alba
authors.forename: Assunta
authors.initials: A
authors.lastname: De Cesare
authors.forename: Federico
authors.initials: F
authors.lastname: Iacopini
mesh_terms: D000368:Aged; D002983:Clinical Competence; D003113:Colonoscopy / Q000379:methods / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D005762:Gastroenterology / Q000193:education*; D006801:Humans; D007077:Ileal Diseases / Q000175:diagnosis*; D008297:Male; D010045:Outpatients; D011446:Prospective Studies