P149 Long-term clinical outcome of isolated terminal ileal lesions

Abstract

Background: Appropriate intubation and observation of the terminal ileum are important during a colonoscopic examination. Although a few individuals may present with erosive or ulcerative lesions in the terminal ileum without concomitant lesions in the colon or at the ileocecal valve, the clinical significance of these lesions remains uncertain. The incidence of inflammatory bowel disease has been rising in Korea; however, the occurrence of intestinal tuberculosis is also common. We aimed to evaluate the clinical course and significance of isolated terminal ileal lesions (ITILs). Methods: We retrospectively analysed the medical records of 343 patients diagnosed with ITILs between January 2007 and April 2017. Among these patients, 71 were included in this study. We excluded 272 patients who reported the use of nonsteroidal anti-inflammatory drugs or the lack of a follow-up colonoscopic examination. We analysed clinical features, endoscopic characteristics, and histopathological findings in 71 patients who presented with ITILs. Results: Among the 343 patients diagnosed with ITILs at the time of an initial colonoscopic examination, 71 underwent a follow-up colonoscopic examination (mean duration 22.3 +/- 19.5 months). The indications for the initial colonoscopic examination included screening for colorectal cancer or surveillance in 50 patients (70.4%) and evaluation for symptoms such as diarrhoea or abdominal pain in 21 (29.6%). Histopathological findings showed non-specific chronic inflammation in 64 patients (90.1%); however, five (7.1%) were diagnosed with Crohn's disease and two (2.8%) with intestinal tuberculosis. Among those who showed non-specific chronic inflammation of the terminal ileum on initial histopathological examination (64 patients), 53 (82.8%) showed resolution of lesions without specific treatment on follow-up colonoscopic examination, whereas the lesions were observed to persist in 11 patients (17.2%). One patient developed Crohn's disease and one developed intestinal tuberculosis, whereas the other 9 did not develop any clinical disease. Conclusions: Most ITILs that are incidentally observed during colonoscopic examination reveal non-specific histopathological findings and resolve without any specific treatment. However, in a small percentage of patients, ITILs need careful attention because these are likely to be the manifestations of early inflammatory bowel disease or intestinal tuberculosis.