Colonoscopic perforation in inflammatory bowel disease

Area of Science:

• Gastroenterology
• Endoscopy
• Inflammatory Bowel Disease (IBD)

Background:

• Colonoscopy is crucial for diagnosing and managing IBD, including assessing disease activity and surveillance.
• Colonoscopy-associated perforation is a severe complication with high mortality and morbidity in IBD patients.
• The use of immunomodulators and biologics increases the importance of understanding and mitigating perforation risks.

Purpose of the Study:

• To review and elucidate the risk factors for colonoscopy-associated perforation in patients with IBD.
• To provide insights into the proper management of colonoscopic perforations in this patient population.

Main Methods:

• Comprehensive review of current literature on colonoscopy-associated perforation in IBD.
• Incorporation of authors' expertise in managing this challenging clinical scenario.

Main Results:

• Patients with IBD exhibit a higher risk of perforation during endoscopic procedures compared to the general population.
• Identified risk factors include female sex, advanced age, severe colitis, corticosteroid use, comorbidities, and stricture dilation.
• Risk factors can be stratified and modified, encompassing disease, technique, and endoscopist-related elements.

Conclusions:

• Understanding and mitigating perforation risks are critical due to the increasing use of advanced therapies in IBD.
• Proper management strategies are essential for addressing this challenging complication in IBD patients undergoing colonoscopy.