Microscopic ileitis in diverted and nondiverted enteric segments: an underrecognized condition with a multifactorial etiology

Zuo, Chunlai; Fu, Zhiyan; Lee, Edward C.; Foulke, Llewellyn; Young, Gloria; Rego, David Cubero; Lee, Hwajeong

doi:10.1016/j.humpath.2018.03.019

Cited by 1 publication

(2 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In 2010, the Standards‐of‐Practice Committee of the ASGE stated that the yield of biopsy of an endoscopically normal‐appearing terminal ileum is likely to be low and highlighted the lack of evidence to determine whether this practice should be routinely performed on patients with chronic unexplained diarrhea 1 . More recently, anecdotal cases of microscopic ileitis have also been described in diverted‐enteric‐segment and collagenous colitis 30 . However, the clinical relevance of microscopic ileitis is still unknown in non‐IBD patients.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Terminal ileum ileoscopy and histology in patients undergoing high‐definition colonoscopy with virtual chromoendoscopy for chronic nonbloody diarrhea: A prospective, multicenter study

et al. 2019

View full text Add to dashboard Cite

Background and aims Ileo-colonoscopy is the procedure of choice for chronic nonbloody diarrhea (CNBD) of unknown origin. 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 by means of 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 dyeless chromoendoscopy (HD + DLC), thereby calculating the impact and cost of routine ileal biopsy in CNBD. Methods Patients with CNBD of unknown origin were prospectively enrolled for ileo-colonoscopy with HD + DLC at five referral centers. Multiple biopsies were systematically performed on each colorectal segment and in the terminal ileum for histopathological analysis. Results Between 2014 and 2017, 546 consecutive patients were recruited. Retrograde ileoscopy success rate was 97.6%. A total of 492 patients (mean age: 53 ± 18 years) fulfilled all the inclusion criteria: Following endoscopic and histopathological work-up, 7% had lymphoid nodular hyperplasia and 3% had isolated ileitis. Compared to the histopathology 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 resulted in a cost of US $26.5 per patient. Conclusions Retrograde ileoscopy with HD + DLC predicts the presence of ileitis in CNBD with excellent performance. The histopathological 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.

show abstract

Section: Discussionmentioning

confidence: 99%

“…1 More recently, anecdotal cases of microscopic ileitis have also been described in diverted-enteric-segment and collagenous colitis. 30 However, the clinical relevance of microscopic ileitis is still unknown in non-IBD patients.…”

Section: Discussionmentioning

confidence: 99%