Results: Literature reviews and two specific case reports demonstrate thetheoretical and practical principles of IOE.Conclusions: The intraoperative endoscopic evaluation of the small bowelis safe and effective when used in managing highly selected patients withGI bleeding, obstruction, or radiographic abnormalities. When used appro-priately and with a team approach that involves both the endoscopist andsurgeon, video enteroscopes, and locally agreed–upon algorithms, intra-operative enteroscopy can help insure successful management of severaldifficult clinical problems.

897

WHAT IS THE DIAGNOSTIC VALUE OF INTUBATING THETERMINAL ILEUM (TI) DURING ROUTINE ADULTCOLONOSCOPY?John B. Marshall, M.D.*. Division of Gastroenterology, University ofMissouri Hospital and Clinics, Columbia, MO.

Purpose: We sought to assess the diagnostic value of intubating the TIduring routine colonoscopy in adults, and correlate the findings with theindication for doing the procedure.Methods: The patient population consisted of 503 consecutive patientsundergoing routine colonoscopy over a 6–month period by one endosco-pist. A brief attempt was made to inspect the TI in all patients. Biopsies ofthe TI and colon were routinely taken in patients in whom the indication forthe procedure was chronic diarrhea (n�47) or CIBD (n�10), or if mac-roscopic ileal abnormalities were identified on inspection.Results: The cecal base was reached in 463 of the 474 patients (97.7%)who had not had a previous colon resection. The TI was intubated in 379of these patients (80.0%). The entire residual colon was examined in 27 of29 patients who had undergone a previous colon resection (93.1%). The TIwas intubated in 21 of these patients (72.4%). Macroscopic abnormalitiesof the TI were identified in only 7 of the 400 patients in whom it wasexamined. Three of these patients had Crohn’s disease (2 carried a previousdiagnosis of CIBD, and the other one was being evaluated for chronicdiarrhea). The other 4 patients with TI abnormalities had small nonspecificerosions that were unexpected and of uncertain clinical signficance. Threeof the 4 patients reported some aspirin or NSAID use. The indication forcolonoscopy in these four patients was colon cancer screening (1/127),polyp on flex sig (1/22), rectal bleeding (1/62), and nonspecific abdominalpain (1/18). No macroscopic ileal lesions were found in patients undergo-ing colonoscopy for polyp F/U (0/57), colon cancer F/U (0/17), �FOBT(0/19) or other miscellaneous reasons (0/21). TI biopsies were normal in 46of 46 patients being colonoscoped for chronic diarrhea when the TI wasmacroscopically normal. Random colon biopsies in this setting had a muchhigher yield, yielding a specific clinical diagnosis in 12 patients.Conclusions: We conclude that the diagnostic yield of routine ileoscopy atthe time of colonoscopy is low in the absence of a history of CIBD orsymptoms suggestive of Crohn’s disease. The yield of taking routine TIbiopsies in patients with chronic diarrhea when the TI appears macroscop-ically normal is also very low and not indicated.

898

TERMINAL ILEOSCOPY: A REVIEW OF CURRENTPRACTICEAhmad Cheema, M.D., Ajay Ponugoti, M.D. and Michael Klamut,M.D.*. Gastroenterology, Loyola University Health System, Maywood,IL.

Purpose: Ileal intubation is uncommonly performed because of time re-striction, low yield & technical difficulty. It is indicated to evaluate in-flammatory bowel disease (IBD),to investigate an abnormality on bariumstudy, or to obtain tissue in suspected inflammatory / infiltrative diseases.This study was designed to retrospectively evaluate the yield of terminalileoscopy as part of routine colonoscopy.Methods: A total of 1728 colonoscopies were done from June 2001,toDecember 2001. 330(19%) out of these also had Ileal intubations per-formed . Computer generated procedure reports and electronic medical

records were reviewed for the latter. Biopsy findings were reviewed witha pathologist for clinical correlation. Patients known to have Inflammatorybowel disease (IBD) and a h/o colonic resection were excluded from thestudy.Results: Of the 330 patients studied (195 females and 135 males), meanage 56 years (range 19 to 93 years), 306 / 330 (95%) had normal Ilealmucosa and 24 / 330 (5%) had abnormal mucosa endoscopically. Ilealbiopsies were obtained from 139 / 330 (42%). Microscopy revealed normalIleal mucosa in 129 / 139 (92.8%) & 10/ 139 (7.2%) were reported asabnormal. In 7 / 10 of these patients biopsy findings and clinical course wasconsistent with a diagnosis of IBD. Non specific inflammation was reportedin the remaining 3.The Indications for procedures in the 10 biopsy positivepatients (5 females, 5 males) were diarrhea in 5, lower gastrointestinalbleed in2 and abdominal pain in 3. The yield of TI scopy in patients withvarying indications was; diarrhea 5.3% (5 / 93 patients), abdominal pain6.9%(3/43 patients) and lower GI bleed 3.1%(2 / 63 patients). The yield ofterminal ileoscopy in all comers was 3% only.Conclusions: This study demonstrates the usefulness of ileoscopy in se-lected patients presenting with diarrhea, abdominal pain and lower GIbleeding. Ileoscopy is useful in establishing the diagnosis in most patientswith crohn’s disease and negative ileal findings make this diagnosis un-likely.

We conclude that there is no apparent need to perform terminal ileoscopyin patients having colonoscopy for screening and polyp or tumor surveil-lance, however patients with diarrhea, abdominal pain and lower GI bleed-ing deserve endoscopic examination and or biopsy of the terminal ileum.

899

FLEXIBLE SIGMOIDOSCOPY: ASSESSING ENDOSCPICSKILLS USING A COMPUTER–BASED SIMULATORMahmoud M. Yousfi, M.D., Darius Sorbi, M.D., Todd Baron, M.D. andDavid E. Fleischer, M.D.*. Gastroenterology and Hepatology, MayoClinic, Scottsdale, AZ.

Introduction: Assessing endoscopic skills is a complex task as onlylimited objectively measurable variables exist. A computer–based endos-copy simulator may be an invaluable training tool to allow objectivemeasurements of individual endoscopic competency.Aim: To seek measurable variables that would distinguish inexperiencedfrom experienced endoscopists.Methods: Consecutive GI endoscopy nurses (no prior hands–on endos-copy experience) and gastroenterologists (experience � 100 colonosco-pies) were invited to participate at the 2002 SGNA and DDW meetings,respectively. The Simbionix GI Mentor was used to assess total proceduretime (sec), total time to transverse colon (sec), screening efficiency (%mucosa examined relative to procedure time), excessive local pressure(times), help requested from virtual instructor (times), 3–dimensional mapuse (times), duration of map use (sec), mucosal surface examined (%), andtime spent with a clear view (%). The Wilcoxon rank sum test was used totest for differences between the two categories of users (JMP 3.1.5, SASInstitute, Cary, NC).Results: The results for the 12 nurses (Beginner) and the 12 gastroenter-ologists (Expert) are as follows:

Table 1

Beginner Expert P value

(Mean � SEM) (Mean � SEM)

Total time (sec) 939.6 � 76.3 221.3 � 20.1 �0.0001Time to transverse colon (sec) 698.1 � 82.0 123.8 � 11.7 �0.0001Screening efficiency (%) 22.2 � 2.0 90.1 � 1.4 �0.0001Excessive pressure (times) 2.4 � 0.6 0 � 0 0.0002Help, virtual instructor (times) 4.3 � 0.9 0.6 � 0.2 0.001Help, 3–D map (times) 5.2 � 0.7 0.5 � 0.2 �0.0001Map use, duration (sec) 85.5 � 34.0 7.4 � 4.9 0.0007

No significant differences were found with regard to percent mucosal surface exam-ined and percent time spent with a clear view.

S295AJG – September, Suppl., 2002 Abstracts