Terminal ileal intubation is not recommended in routine colonoscopy: data from a large-scale retrospective study

Abstract Background Terminal ileal intubation (TII) demonstrates a complete colonoscopy, but whether it should be performed in routine colonoscopies remains uncertain. We aimed to explore the diagnostic yield of TII in routine colonoscopy and investigate the association of TII and the detection of lesion. Methods We conducted a retrospective study included patients who underwent colonoscopy with cecal intubation at our endoscopic center between November 1 2022 and July 31 2023. Macroscopic and histologic findings of terminal ileum were recorded. We used propensity score matching to adjust for differences between groups and further analyzed the difference of polyp detection rate (PDR), adenoma detection rate (ADR), sessile serrated lesion detection rate (SSDR) and right-sided lesion detection rate between patients underwent TII or not. Results There were 13372 patients with cecal intubation colonoscopy, including 7599 (56.8%) with TII and 5773 (43.2%) without TII. Abnormal endoscopic findings were observed in 150 of 7599 unselected individuals and only 7 of these cases were regarded as pathologically significant. Likewise, abnormal endoscopic findings were found in 20 of 1494 asymptomatic individuals with 19 nonspecific ileitis determined by histopathology. After PSM, there were no significant differences in PDR (51.5% vs 50.8%, P = 0.506), ADR (31.3% vs 30.0%, P = 0.156), SSDR (1.7% vs 1.8%, P = 0.613) and right-sided lesion detection rate (16.5% vs 16.5%, P = 1.000) between the two groups. Conclusion TII was not proposed in routine colonoscopy, owing to the limited diagnostic value and lack of superiority on lesion detection.