title: Factors associated with perforation related to diagnostic balloon-assisted enteroscopy: analysis of a national inpatient database in Japan.
abstract: OBJECTIVE
  Balloon-assisted enteroscopy (BAE) is a well-established procedure that is used worldwide for investigation of the small intestine. Previous reports describing the factors associated with perforation related to diagnostic BAE were limited by inclusion of only small numbers of patients who were mostly treated at a few specialized centers. The aim of this study was to clarify the factors associated with perforation by analysis of a large multicenter database.
  
  
  METHODS
  This study retrospectively analyzed data from the Diagnosis Procedure Combination database in Japan. Patients who underwent diagnostic BAE between July 2007 and March 2013 were included. The primary outcome was the occurrence of perforation requiring open surgery. Logistic regression analysis was used to identify factors associated with perforation.
  
  
  RESULTS
  A total of 29 068 patients who underwent diagnostic BAE during the study period were identified. Perforation occurred in 32 patients (0.11 %). Univariable logistic regression analysis showed that patients with inflammatory bowel disease (IBD) on steroids had a significantly higher risk of perforation (odds ratio 8.55; 95 % confidence interval 2.87 - 25.5; P < 0.001). Non-IBD patients on steroids had an approximately three-fold higher risk of perforation compared with patients who were free from IBD and not taking steroids.
  
  
  CONCLUSIONS
  Our results suggest that patients with IBD who are using steroids have the highest risk of perforation related to diagnostic BAE.
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Odagiri
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsui
authors.affiliation: Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.affiliation: Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Kaise
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
mesh_terms: D000368:Aged; D058582:Double-Balloon Enteroscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000188:drug therapy; D007410:Intestinal Diseases / Q000175:diagnosis; D007416:Intestinal Perforation / Q000453:epidemiology / Q000209:etiology*; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D013256:Steroids / Q000009:adverse effects*
chemical_list: D013256:Steroids