Ileum Intubation: Tips and Tricks
Terminal ileum intubation is the clearest confirmation that you reached the cecum, and it enables direct mucosal evaluation of the ileum itself. The ileocecal valve, depending on its clock-face position on the screen, demands a different entry approach. Matching your scope torque and wheel inputs to that position is the difference between a clean first-pass entry and a failed attempt.
The Two Key Valve Positions
The ileocecal valve most commonly presents in one of two positions: around 9 o’clock (spanning 9 to 11, on the left side of the screen) or around 6 o’clock (spanning 6 to 7, at the bottom of the screen). Identifying the position before your first attempt tells you exactly which torque direction and wheel input to use.
To cross the valve lips cleanly, you need controlled torque, targeted air insufflation, and water flushes. Water infusion is particularly useful for opening the valve orifice, especially when the scope’s water channel faces the valve.
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