title: High incidence of colonic perforation during colonoscopy in hemodialysis patients with end-stage renal disease.
abstract: OBJECTIVE
  Colonic perforation is a rare but life-threatening complication of colonoscopy. We evaluated the incidence of colonic perforation that resulted from colonoscopy in patients who underwent hemodialysis compared with those who did not have this procedure (controls).
  
  
  METHODS
  Data from a total of 15,098 consecutive patients who underwent colonoscopy from January 2001 to December 2008 in Nagoya Kyoritsu Hospital were analyzed retrospectively. Patients were divided into 2 groups: 1106 hemodialysis patients and 13,992 controls. The incidence of colonic perforation, patient characteristics, and locations of perforation during colonoscopy were compared between the 2 groups. Furthermore, perforated mucosa samples from colons were examined by pathology analysis.
  
  
  RESULTS
  Colonic perforations occurred in 5 hemodialysis patients and 3 controls. The incidence of colonic perforation was markedly higher in the hemodialysis group than in the control group (0.45% vs 0.02%; odds ratio, 21.17; 95% confidence interval, 5.05-88.73; P < .0001). Even after multivariate analysis of age, sex, and patients who received polypectomies, hemodialysis still was associated independently with the risk of colonic perforation during colonoscopy (odds ratio, 19.91; 95% confidence interval, 4.61-85.93; P < .0001). Pathologic examination of perforated mucosa was performed in 3 hemodialysis patients and 3 control patients. beta2-microglobulin deposition was observed in all 3 hemodialysis patients. In contrast, beta2-microglobulin deposition was not detected in control patients.
  
  
  CONCLUSIONS
  There is a higher risk of colonic perforation during colonoscopy among patients who received hemodialysis compared with those who did not. beta2-microglobulin deposition might have a role in perforation in patients who receive hemodialysis.
authors.affiliation: Department of Gastroenterology, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan. norihiro.imai@gmail.com
authors.forename: Norihiro
authors.initials: N
authors.lastname: Imai
authors.forename: Kinichi
authors.initials: K
authors.lastname: Takeda
authors.forename: Teiji
authors.initials: T
authors.lastname: Kuzuya
authors.forename: Setsuo
authors.initials: S
authors.lastname: Utsunomiya
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takahashi
authors.forename: Hirotake
authors.initials: H
authors.lastname: Kasuga
authors.forename: Masami
authors.initials: M
authors.lastname: Asai
authors.forename: Michiko
authors.initials: M
authors.lastname: Yamada
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Tanikawa
authors.forename: Hidemi
authors.initials: H
authors.lastname: Goto
mesh_terms: D000368:Aged; D003108:Colonic Diseases / Q000453:epidemiology*; D003113:Colonoscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007416:Intestinal Perforation / Q000453:epidemiology*; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D001613:beta 2-Microglobulin / Q000378:metabolism
chemical_list: D001613:beta 2-Microglobulin