Ileal biopsy: Clinical indications, endoscopic and histopathologic findings in 10,000 patients.

Background: Ileal biopsies are often reported as having a low yield. Data from endoscopy practices in the private setting are lacking.

Aims: To correlate the frequency of histologic abnormalities in ileal biopsies with clinical indications and ileoscopic appearances.

Methods: Retrospective analysis of clinical, endoscopic, and histopathologic data from a large database.

Results: We studied 9785 unique adult patients (median age 46 years, 61.4% women) with ileal biopsies. The most common symptoms were diarrhoea (52.2%) and abdominal pain (37.1%). Ileoscopy was reported as being normal in 75.1% patients. Subjects screened for cancer had the highest prevalence of abnormal endoscopic findings (63.3%); patients with known or suspected Crohn's had the highest prevalence abnormal ileal histology (36.4%). Overall, 5.0% of ileal biopsies obtained from patients with normal endoscopy and 47.4% of biopsies from patients with an endoscopically abnormal ileum had significant histopathologic findings.

Conclusions: In adults, biopsies from the endoscopically normal ileum rarely provide clinically relevant information and cannot be recommended. In contrast, half of the adult patients with an endoscopically abnormal ileum have significant histopathologic findings in ileal biopsies. Therefore, ileoscopy associated with a sensible use of the ileal biopsy is a valuable complement to the colonoscopy.