The purpose of documenting 'completion' of a colonoscopy is to provide objective evidence for a given procedure that a complete
examination of the colon has been made.
Satisfactory evidence of completion is considered to be:-
a photo of the terminal ileum where villi or lymphoid hyperplasia can be clearly seen, or
a photo of the terminal ileum where the ileo-cecal valve, either open or en face, can be clearly seen, or
a photo of the appendiceal orifice where either the caecal strap fold or the ICV can also be clearly seen in the same image or
a pathology report of mucosa of the caecum or terminal ileum.
The tri-radiate fold was deemed not to be a good indicator, as it is present in only about 20% of patients and can be too easily
misinterpreted e.g. as just another colonic fold.
The following images are provided as examples of what will be considered sufficient or insufficient as photographic evidence for
Sufficient: This photograph clearly demonstrates the presence of villi in the terminal ileum. An image comparable in content
and clarity to this image would meet the requirements for photographic documentation. The introduction of water into the
ileum has been suggested by some to help enhance the appearance of the villi in photos but was not needed in this instance.
Not sufficient on its own: While this is a photograph of the ileum, it does not clearly show the villi or lymphoid hyperplasia.
A second photograph showing those features or features from the caecum would be required.
Sufficient: This photograph clearly shows the ileo-caecal valve en-face.
Sufficient: This photograph also clearly shows the ileo-caecal valve.
Not sufficient on its own: This image shows the IC valve and the tri-radiate fold but a second image is required to
document either the ileum or other caecal features such as the appendiceal orifice or the IC valve en-face.
Sufficient: This photograph shows the caecum from just distal to the IC valve and the appendiceal orifice can be seen with the caecal strap fold.
Sufficient: This photograph shows the appendiceal orifice with the caecal strap fold.