Colonoscopy and ileoscopy: essential tests for diagnosing IBD

May 5, 2023


Diarrhoea, abdominal pain, blood in stool, anaemia, fatigue, fever, weight loss. These are signs that can signal a digestive problem. As soon as it is suspected that a patient might have an inflammatory bowel disease (IBD), such as ulcerative colitis or Crohn’s disease, the healthcare professional needs reliable diagnostic tools to confirm these conditions, ruling out other types of diseases with similar symptomatology.

In addition to analytical tests on both blood and stool and radiological tests, endoscopic tests are a fundamental and invaluable technique for diagnosing IBD.

Enteroscopy, endoanal ultrasound, capsule endoscopy, upper gastrointestinal endoscopy or gastroscopy, and lower gastrointestinal endoscopy or ileocolonoscopy are included within these endoscopic tests. We will explain what this last technique, which includes colonoscopy and ileoscopy, consists of.

Ileocolonoscopy as a diagnostic tool

Ileocolonoscopy is one of the most common endoscopic tests performed to diagnose IBD. Thanks to it, healthcare professionals can view the intestinal mucosa directly, both the colon (colonoscopy) and the end of the small intestine or terminal ileum (ileoscopy).

Thus, it is possible to know whether a patient has Crohn’s disease or ulcerative colitis as the endoscopic features are singular and different to one another. Furthermore, it helps to choose the more suitable therapeutic option and surgical procedure, if necessary. The point is that the extent and severity of the damage, as well as its exact location in the colon and terminal ileum, can be visualised.. In the case of Crohn’s disease, it is normal for the ileum to be affected, hence the appropriateness of performing an ileoscopy alongside a colonoscopy in these cases.

On the other hand, these techniques are effective tools for ruling out drug-induced diseases, like anti-inflammatory drugs, or other types of conditions with similar symptoms, such as infectious colitis. Moreover, it is possible to take a biopsy (tissue samples) during the test, where necessary, to perform an anatomical-pathological examination or therapeutic procedures. This is the case of polypectomy (removal of polyps) or dilation of strictures (reduction of internal diameter of the intestine).

Long-term monitoring of a patient with IBD

Performing a long-term follow-up of the inflammatory disease’s progression is fundamental to anticipate flare-ups, assess the efficacy of the treatment and modify it if necessary. In this case, ileocolonoscopy is very useful as the extension and evolution of the condition can be viewed in the colon and the end of the small intestine or terminal ileum.

Patients with long-standing IBD are more likely to develop colorectal cancer than the general population. This risk that is higher or lower depending on the duration and extension of the disease. For this reason, endoscopic monitoring via ileocolonoscopy can be an effective tool for detecting pre-malignant lesions and acting as soon as possible, thus reducing the mortality rate associated with colorectal cancer. Another situation where it is very useful to perform an ileocolonscopy is after surgery. In fact, it is considered the ‘gold standard’ as it allows to establish the onset of morphological recurrence and its severity, which is directly related to the long-term clinical course1.

How should the patient prepare for the test?

Like any endoscopic procedure, both colonoscopy and ileoscopy require the patient to undergo pre-test preparation. These preparations include a special diet and, occasionally, the withdrawal of some of the drugs they are taking. In this latter case, the healthcare professional will inform you how to proceed with these drugs in order to avoid complications that may hinder the examination.

As for the diet2 that the patient should follow before the test, two days before it, he/she should start a low-residue diet. This means that fatty cheeses, full-fat dairy products, oily fish, fatty meats, cold meats, wholemeal products, fruits, vegetables, legumes, chocolate, pastries and dried fruit are forbidden.

On the other hand, the foods that can be eaten during the special diet are: skimmed milk and natural yoghurt, fresh cheeses, hard cheeses and a bit of butter; white bread or non-wholemeal toast and biscuits; soups without vegetables; non-wholemeal rice and pastas; skinless mashed or boiled potatoes; grilled or cooked white meat and fish; skinless quince, peaches in syrup, cooked or roasted apples or pears; tea, coffee or light infusions.

Colon cleansing will be started the day before the colonoscopy or ileoscopy, with preparations given by the medical professional. These can be polyethylene glycol solutions, magnesium salts, sodium phosphate solutions or enemas. However, the patient must stop eating solid foods 3 or 4 hours before starting the colon cleanse.From then on, they can only have clear liquids, in other words, water, infusions, filtered soups, coffee or tea, strained fruits juices and clear soft drinks. On the day of the test, the patient must stop drinking clear liquids 3-4 hours before the colonoscopy or ileoscopy is performed.

During and after the ileocolonoscopy

The test is performed in the Endoscopy Unit of the Gastroenterology Department. The test is carried out by Digestive specialist doctors with training in diagnostic and therapeutic endoscopy from the IBD Unit itself or, failing that, with IBD training.

Nursing staff specialised in endoscopy and nursing assistants also participate. Their function during ileocolonoscopy is to care for and look after the patient, help the endoscopist perform the test and administer the necessary medication.

Regarding the duration of the test, it can range from 20 to 60 minutes. It depends on the amount of intestine to be examined and, if it is necessary to perform any therapeutic procedure during the test. Moreover, sedation and intravenous analgesics are often administered to avoid discomfort for the patient and to perform the test without any pain.

After completing the examination, the patient is taken to another room where they will awaken with a feeling of abdominal bloating and discomfort that is similar to intestinal colic. This is due to the insufflated air inside the intestine during the examination. This discomfort will disappear after a few hours.


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