Pathologic and Clinical Findings in over 10,000 Biopsies of the Terminal Ileum
SD Melton, MH Saboorian, RM Genta. Dallas VAMC - UT Southwestern Medical Center, Dallas, TX; Caris Diagnostics, Irving, TX
Background: Biopsy of the terminal ileum (TI) is a common modality for evaluating Crohn's disease (CD), certain infections, and any abnormalities localized by imaging. Previous reports have shown normal histology in 82% to 97.3% of TI biopsies, depending on the patient population. Our study aims to address the TI biopsy in the private setting, correlating the clinical and histologic findings in more than 10,000 patients.
Design: Using a nation-wide database, we extracted all patients who had a colonoscopy with at least one biopsy in a 12-month period. A separate database was then prepared to include only patients in whom ileal tissue was identified histologically. Demographic, clinical, and histopathologic information was then analyzed.
Results: Of 178,963 unique patients who underwent a colonoscopy with at least one biopsy specimen, biopsies from the TI were available in 10,279 (median age 46 years, 59.0% female). The most common clinical indications for colonoscopy in these patients were abdominal pain (26.4%); diarrhea (21.1%); and suspicion of inflammatory bowel disease (22.8%), with CD accounting for 9.9%; and screening (7.5%). Overall, ileal biopsies were unremarkable in 76.2% of cases. Of patients with suspected CD; only 50.3% of biopsies were normal, while 19.1% had chronic active ileitis and 15.9% active ileitis. Only 63.2% of patients undergoing screening colonoscopy had a histologically unremarkable TI. Active ileitis was seen in 10.4% of TI biopsies; occurring in 16.8% of screened patients, 12.3% of patients with anemia, and 9.9% of those with abdominal pain. Concurrent duodenal biopsies were also available in 2051 (19.9%) patients. Duodenal intraepithelial lymphocytosis (DIL) was diagnosed in 116 (5.7%) celiac disease in 24 (1.2%) patients. Of the 24 patients diagnosed with sprue in the duodenum, 10 had lymphocytosis also in the TI, 9 had unremarkable ileal mucosa, and 4 had sprue. Pathologic changes in the TI were present in 17.2% of patients with DIL.
Conclusions: This study shows that in a nation-wide population who had colonoscopy in a private setting, the value of TI biopsies is not limited to the investigation of CD. Although only a small percentage of patients undergoing screening colonoscopy had TI biopsies, 37.7% of these showed significant and unexpected pathology.
Wednesday, March 24, 2010 9:30 AM
Poster Session V # 55, Wednesday Morning