Routine ileoscopy at colonoscopy: a prospective evaluation of learning curve and skill-keeping line.
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.
Iacopini
Giampaolo
G
U.O.C. di Gastroenterologia ed Endoscopia Digestiva, Ospedale San Giovanni-Addolorata-Calvary, Istituto Superiore di Sanità, Roma, Italy.
Frontespezi
Stefano
S
Vitale
Mario Alessandro
MA
Villotti
Giuseppe
G
Bella
Antonino
A
d'Alba
Lucia
L
De Cesare
Assunta
A
Iacopini
Federico
F
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