ileum jejuno
Terminal ileum.

Video Endoscopic Sequence 1 of 2.

Terminal ileum.

Normal villi of the ileum.
Tips of the villous projections look like dots.

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Terminal ileum.

Video Endoscopic Sequence 2 of 2.

Terminal ileum.

Finger-like villi are clearly observed.

Terminal Ileum.

Terminal Ileum.

The terminal ileum is notable for the speckled light pattern due to the presence of villi and lymphoid nodules. This is less striking in the ileum than in the jejunum.

Terminal ileum.

Video Endoscopic Sequence 1 of 3.

Terminal ileum.

Colonoscopy is an established procedure for investigating patients with diseases of the colon and terminal ileum, including patients with prior colonic adenomas or cancer, fecal occult blood loss, a family history of cancer, inflammatory bowel disease, evaluation of iron deficiency anemia and patients with hematochezia. However, although it is expected that endoscopists should be able to intubate the cecum in 90% of attempts, in practice this is followed less often than not.

On several occasions even a complete colonoscopic examination may not be possible or may not show any abnormality in patients with hematochezia. Moreover, during active bleeding subtle changes in the colon may not be appreciated and sometimes even gross lesions may be missed.

 

Terminal ileum.

 

 

 

Terminal ileum.

Video Endoscopic Sequence 2 of 3.

Endoscopy of Terminal ileum.

Due to this argument and the fact that most of the bleeding will stop by itself, some workers advise that colonoscopy should be performed only after cessation of active bleeding and after proper colonic preparation.

On the contrary, others prefer to perform colonoscopy as an emergent procedure, so that more lesions are detected early enough for endoscopic therapy to be applied.

Ileoscopy

Video Endoscopic Sequence 3 of 3.

Ileoscopy

Terminal ileoscopy is an integral part of complete colonoscopy.

Retrograde terminal ileoscopy has been noted to be useful in patients with inflammatory bowel disease, diarrhea, lymphoma, cytomegalovirus-induced ileitis, tuberculosis, portal hypertension and a host of other conditions involving the terminal ileum.

In a recent study, It have been reported that obtaining blind biopsies from even a normal-appearing terminal ileum is useful in patients suspected to have ileocecal tuberculosis.

Enteroscopy

Video Endoscopic Sequence 1 of 2.

Enteroscopy

The small intestine is the most difficult part of the gastrointestinal tract to evaluate due to its length and complex loops.

Disadvantages of conventional endoscopic techniques such as push enteroscopy and colonoscopy with ileoscopy include limited endoscopic examination of the small bowel and sedation requirements.

A complete endoscopic evaluation was previously possible only with intraoperative endoscopy.

Enteroscopy

Video Endoscopic Sequence 2 of 2.

Enteroscopy allowing complete examination of small intestine, notoriously one of the most inaccessible areas of the GI tract.

Intestinal bleeding remains the most common indication for enteroscopy. Bleeding may be acute or chronic, observed or occult in nature.

The small intestine beyond the ligament of Trietz may be the source of bleeding in up to 5% of patients presenting with gastrointestinal bleeding.

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