Severe Disease on Endoscopy and Steroid Use Increase the Risk for Colonic Performation During Colonoscopy in Inflammatory Bowel Disease Patients

Abstract

Purpose: Colonoscopic perforation is a rare complication. We sought to determine its risk factors in patients with inflammatory bowel disease (IBD) patients. 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 during the same period and had no perforations who were matched based on diagnostic and therapeutic 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 5,295 colonoscopies done during the study period in IBD patients of which 19 patients had perforation. Among the 19 perforations, 13 were in diagnostic colonoscopies and 6 were with therapeutic colonoscopies. The prevalence of perforation in general was 0.3%, in diagnostic colonoscopy was 0.2%, and with therapeutic colonoscopy was 1.2%. Of the 19 patients, 12 had Crohn's disease (CD) and 7 had ulcerative colitis (UC); 10 (52.6%) had outpatient colonoscopy and 9 (47.4%) had inpatient colonoscopy. The mean age was 36.58 ± 15.70 years in the study group and 44.61 ± 15.02 years in the control group (p=0.04). Patients in the perforation group were more likely treated with steroids (68.4% vs. 21.1%, p<0.001) and had severe disease (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] = 3.92, 95% confidence interval [CI] = 1.17 - 13.20) and steroid treatment (aOR = 7.68; 95% CI=1.48, 39.81) were independently associated with the risk of perforation, while colonoscopy performed by the IBD specialists (aOR = 0.22; 95%CI= 0.06, 0.85) appeared to be protective against the risk of perforation. (Table 1) All but one patient underwent surgery for perforation. There was no mortality in our study.Table 1: Multivariate adjusted odds ratio (aOR) for colonic perforation among all patientsConclusion: There appears to be a higher risk of colonoscopy-associated perforation in IBD patients with active disease and on steroids. Colonoscopy done by IBD specialists seem to be protective against the risk of perforation.