title: Severe adverse outcomes of endoscopic perforations in patients with and without IBD.
abstract: BACKGROUND
  Endoscopy-associated perforation (EAP) is a dreaded adverse event with significant morbidity and even mortality. Whether EAP in patients with inflammatory bowel disease (IBD) is associated with worse outcomes is not known. We aimed to assess the frequency of perforations in patients undergoing lower gastrointestinal (GI) endoscopies and compare the risk factors and perforation-associated complications (PAC) in patients with IBD with those without IBD.
  
  
  METHODS
  In this case-control study, we identified patients with lower GI EAP from January 2002 to June 2011. PAC was defined as EAP-associated death, colectomy with ileostomy, and bowel resection with/without diverting ostomy. Twenty-nine demographic, clinical, endoscopic, and surgical features were evaluated in univariable and multivariable analyses.
  
  
  RESULTS
  A total of 217,334 lower GI endoscopies were performed (IBD, N = 9518 and non-IBD, N = 207,816). Eighty-four patients with EAP were included. The rate of perforation was 18.91 per 10,000 and 2.50 per 10,000 procedures for IBD and non-IBD endoscopy, respectively. PAC occurred in 59 patients (70.2%) with death in 4 (4.8%) and bowel resection with or without ostomy in 55 (65.5%) (total colectomy with ileostomy, n = 3; resection with diversion and secondary anastomosis, n = 28; and resection with primary anastomosis, n = 24). On multivariable analysis, the use of systemic corticosteroids at the time of endoscopy was associated with 13 times greater risk for PAC (13.5 [95% confidence interval, 1.3-1839.7] P = 0.007), whereas IBD was not found to be associated with an increased risk for PAC (0.69 [95% confidence interval, 0.23-2.1] P = 0.52).
  
  
  CONCLUSIONS
  Patients with IBD have a higher frequency of EAP than those without IBD. Endoscopists need to be cautious while performing a lower GI endoscopy in patients taking systemic corticosteroids.
authors.affiliation: Departments of *Gastroenterology and Hepatology and †Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Mukewar
authors.forename: Meagan
authors.initials: M
authors.lastname: Costedio
authors.forename: Xianrui
authors.initials: X
authors.lastname: Wu
authors.forename: Navkaran
authors.initials: N
authors.lastname: Bajaj
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.forename: Aaron
authors.initials: A
authors.lastname: Brzezinski
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003082:Colectomy; D003113:Colonoscopy; D004724:Endoscopy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D007416:Intestinal Perforation / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010030:Ostomy; D011379:Prognosis; D012307:Risk Factors