title: Colonoscopic perforation in inflammatory bowel disease.
abstract: Colonoscopy has become the diagnostic and therapeutic modality of choice in patients with inflammatory bowel disease (IBD) by allowing for the assessment of disease extent and activity; the distinction between ulcerative colitis, Crohn's disease, and other differential diagnoses; the surveillance of dysplasia; and the delivery of treatment (eg, stricture dilation). Colonoscopy-associated perforation is a dreaded complication associated with significant mortality and morbidity. Understanding and mitigating the risks of perforation in patients with IBD has become an important issue with the increasing use of immunomodulators and biologic agents. Studies have shown that patients with IBD are at a higher risk for perforation from diagnostic or therapeutic endos-copy than individuals in the general population. Reported risk factors associated with colonoscopic perforation include female sex, advanced age, severe colitis, use of corticosteroids, presence of multiple comorbidities, and stricture dilation. Disease-, tech-nique-, and endoscopist-associated risk factors for perforation can be stratified and modified. This review, based on current available literature and the authors' expertise, should shed some light on the proper management of this challenging disease phenotype.
authors.affiliation: Dr Makkar is a fellow in the Department of Gastroenterology and Hepatology at The Cleveland Clinic Foundation in Cleveland, Ohio. Dr Shen is a professor of medicine and the Ed and Joey Story Endowed Chair at The Cleveland Clinic Foundation.
authors.forename: Rohit
authors.initials: R
authors.lastname: Makkar
authors.affiliation: Dr Makkar is a fellow in the Department of Gastroenterology and Hepatology at The Cleveland Clinic Foundation in Cleveland, Ohio. Dr Shen is a professor of medicine and the Ed and Joey Story Endowed Chair at The Cleveland Clinic Foundation.
authors.forename: Shen
authors.initials: S
authors.lastname: Bo
keywords: Colonoscopy; Crohn’s disease; endoscopy; inflammatory bowel disease; perforation; stricture dilation; ulcerative colitis
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