Is routine terminal ileum intubation justified during screening colonoscopy? Evidence from a regional screening program.

Background∕Aim: Although colonoscopy represents the cornerstone of colorectal cancer (CRC) screening, the incremental diagnostic yield of routine terminal ileum (TI) intubation remains insufficiently defined, particularly in fecal immunochemical test (FIT) positive patients. This study evaluated the feasibility, diagnostic performance, and clinical relevance of routine TI intubation in participants enrolled in a regional CRC screening program. PATIENTS, MATERIALS AND METHODS: We performed a retrospective analysis of individuals aged 50-74 years who underwent colonoscopy within a regional CRC screening program in South-West Romania between November 2020 and December 2023. Patients with successful TI intubation were compared with individuals in whom TI exploration was not performed. Demographic characteristics, bowel preparation quality, sedation parameters, comorbidities, procedural variables, and histopathological (HP) outcomes were assessed. RESULTS: The analysis included 1512 complete colonoscopies, of which TI intubation was successfully achieved in 41.86% of procedures. Macroscopic TI abnormalities were identified in 1.74% of patients, including erosions, ulcerations, hyperemia, and nodular or atrophic changes. HP analysis showed findings suggestive of inflammatory bowel disease in 27.27%, celiac disease-related changes in 9.09%, and nonspecific inflammatory alterations in 63.64% of abnormal cases. Successful TI exploration was more commonly observed in patients receiving sedation and in those with better bowel preparation. No significant associations were observed regarding age, sex, or FIT values. CONCLUSIONS: Routine TI intubation demonstrated a relatively limited diagnostic yield in this screening population. Although clinically meaningful findings were uncommon, TI assessment may remain valuable in selected clinical settings. Further prospective studies are needed to establish its role in screening colonoscopy.