High incidence of colonic perforation during colonoscopy in hemodialysis patients with end-stage renal disease.
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.
Imai
Norihiro
N
Department of Gastroenterology, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan. norihiro.imai@gmail.com
Takeda
Kinichi
K
Kuzuya
Teiji
T
Utsunomiya
Setsuo
S
Takahashi
Hiroshi
H
Kasuga
Hirotake
H
Asai
Masami
M
Yamada
Michiko
M
Tanikawa
Yutaka
Y
Goto
Hidemi
H
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
D001613:beta 2-Microglobulin