We examined the frequency of total colonoscopy and terminal ileal intubation in a training setting using modern videoendoscopic equipment and techniques with examinations supervised or done by the two authors. The cecum was considered reached if the endoscopic report included a description of the cecal landmarks visualized and if electronic images documenting these landmarks were obtained. One of us also routinely attempted terminal ileal intubation for documentation purposes, allotting a minute or two for the purpose. In cases of chronic diarrhea and possible inflammatory bowel disease, a more prolonged attempt was made to visualize the terminal ileum. Among 418 consecutive colonoscopies, the cecum was reached in 96% of cases. If cases of malignant obstruction were excluded, the success rate improved to 97%. When routinely attempted, the terminal ileum was intubated and inspected in 74% of cases (excluding cases of malignant obstruction). In cases in which terminal ileal intubation and inspection was deemed necessary, the success rate was 91%. We conclude that total colonoscopy can be accomplished in the 1990s in excess of 90% of cases and can be documented by high-quality photographs that can be attached to the procedure report. High rates of successful total colonoscopy should be attainable even in training programs. Routine intubation of the terminal ileum can be performed to provide further objective proof of the extent of colonoscopy and to allow the endoscopist to develop and maintain the skill. A skilled, practiced endoscopist can inspect the terminal ileum in about 90% of cases in which such examination is needed.
