title: Severe disease on endoscopy and steroid use increase the risk for bowel perforation during colonoscopy in inflammatory bowel disease patients.
abstract: OBJECTIVE
  Colonoscopic perforation is a rare complication. We sought to determine its risk factors in patients with inflammatory bowel disease (IBD).
  
  
  METHODS
  The study group consisted of 19 IBD patients who had perforation secondary to diagnostic or therapeutic colonoscopy from January 2002 to October 2010. The control group consists of 76 IBD patients undergoing colonoscopy and no perforations that were matched based on indication in a 4:1 ratio to the study group. Demographic and clinical variables as well as perforation outcomes were analyzed by univariate and multivariate analyses.
  
  
  RESULTS
  There were a total of 5295 colonoscopies done during the study period in IBD patients of which 19 patients had perforation. The prevalence of perforation in IBD patients was 0.3%. Of the 19 patients, 12 had Crohn's disease (CD) and 7 had ulcerative colitis (UC). Patients in the perforation group were more likely treated with steroids (68.4% vs. 21.1%, p<0.001) and had severe disease on endoscopy (31.6% vs. 10.1%, p=0.03) than that in the control groups. On multivariate analysis, severe disease on endoscopy (adjusted odds ratio [aOR]=3.82, 95% confidence interval [CI]=1.03-15.24) and steroid treatment (aOR=7.68; 95% CI=1.48, 39.81) were independently associated with the risk of perforation. The median length of stay in the perforation group was 10 days (range 2-23 days). There was no mortality in our study.
  
  
  CONCLUSIONS
  There appears to be a higher risk of colonoscopy-associated perforation in IBD patients with active disease and on steroids.
authors.affiliation: Department of Gastroenterology, Digestive Disease Institute, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA. navaneu@ccf.org
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
authors.forename: Gursimran
authors.initials: G
authors.lastname: Kochhar
authors.forename: Hardeep
authors.initials: H
authors.lastname: Phull
authors.forename: Preethi G K
authors.initials: PG
authors.lastname: Venkatesh
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Kiran
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003113:Colonoscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000145:classification / Q000150:complications* / Q000175:diagnosis; D007416:Intestinal Perforation / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012306:Risk; D012307:Risk Factors; D013256:Steroids / Q000009:adverse effects*
chemical_list: D013256:Steroids