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P681 Incidence of endoscopically and histologically confirmed ileal ulceration in a sequential cohort of patients undergoing screening colonoscopy as part of the UK Bowel Cancer Screening Programme

M. McDonnell*, A. Al Badri, S. Burningham, J. Gordon

Royal Hampshire County Hospital, Hampshire Hospitals NHS Foundation Trust, Winchester, Hampshire, SO22 5DG, United Kingdom

Background

The incidence of ileal ulceration in patients presenting for colonoscopy within the UK Bowel Cancer Screening Programme (BCSP) is unknown. Terminal ileal intubation is not a prerequisite of the programme and usually not performed on a systematic basis. Anecdotally we became aware that ileal ulceration was a surprisingly common finding. We therefore decided to prospectively evaluate the incidence of ileal ulceration in sequential patients presenting for colonoscopy through the BCSP.

Methods

All sequential patients being endoscoped by a single BCSP colonoscopist over a 28 month period from July 2012 were prospectively audited. All patients had been referred for colonoscopy on account of positive faecal occult blood samples performed as part of the UK BCSP. Terminal ileal intubation was planned at the outset in all cases. If ileal ulceration was seen it was photographed and biopsied. Current symptoms, past medical and drug history was recorded in all cases. Histology was reported by BCSP pathologists, with all cases of ileal ulceration subsequently reviewed by a specialist gastrointestinal pathologist.

Results

354 sequential colonoscopies were undertaken by a single BCSP colonoscopist (JNG) during the study period. Terminal ileal intubation was achieved in 327/354 (92.4%) of cases. Endoscopic evidence of terminal ileal ulceration was found in 28/327 (8.6%) of cases where the ileum was intubated. Ulceration was confirmed on biopsy in 24/327 (7.3%) cases. 2/24 cases had previously diagnosed Crohn's disease (1 on active follow-up, the other historical) and a further 5/24 patients were taking regular NSAIDS. The remaining 17/327 (5.2%) with both endoscopic and histological evidence of terminal ileal ulceration had no known risk factors.

Conclusion

In this study endoscopically and histologically confirmed ileal ulceration was a common finding occurring in 7.3% of cases. This is the first study to document these findings prospectively in a sequential cohort of BCSP patients where intubation of the terminal ileum was attempted in a systematic manner. The incidence is dramatically higher than that previously reported in non-BCSP cohorts. Some cases can be attributed to drug use with the remainder appearing likely to be either physiological or potentially represent Crohn's disease. The clinical relevance of these findings is currently unknown though it is pertinent that many patients in this cohort either had symptoms or had been previously been investigated for IBS or a change in bowel habit.