Brief Article
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World J Gastroenterol. Jun 21, 2013; 19(23): 3596-3601
Published online Jun 21, 2013. doi: 10.3748/wjg.v19.i23.3596
Risk factors for colonoscopic perforation: A population-based study of 80118 cases
Uzair Hamdani, Raza Naeem, Fyeza Haider, Pardeep Bansal, Michael Komar, David L Diehl, H Lester Kirchner
Uzair Hamdani, Pardeep Bansal, Michael Komar, David L Diehl, Department of Gastroenterology, Geisinger Medical Center, Danville, PA 17822, United States
Raza Naeem, Department of Gastroenterology, Good Samaritan Hospital, Vincennes, IN 47591, United States
Fyeza Haider, Central Indiana Gastroenterology, Anderson, IN 46016, United States
H Lester Kirchner, Division of Medicine, Gesinger Medical Center, Danville, PA 17822, United States
Author contributions: Hamdani U made the contribution to conception and designed research, acquisition of data and interpretation of data, wrote the paper; Naeem R, Haider F, and Bansal P made the contribution to data gathering and study design and drafting the manuscript; Komar M and Diehl DL made the contribution to revising it critically for important intellectual content; Kirchner HL made the contribution to statistical analysis, study design and methods.
Correspondence to: Uzair Hamdani, MD, Department of Gastroenterology, Geisinger Medical Center, 100 N Academy Ave, Danville, PA 17822, United States.
Telephone: +1-803-3478181 Fax: +1-570-2716852
Received: November 19, 2012
Revised: January 12, 2013
Accepted: April 13, 2013
Published online: June 21, 2013

AIM: To assess the incidence and risk factors associated with colonic perforation due to colonoscopy.

METHODS: This was a retrospective cross-sectional study. Patients were retrospectively eligible for inclusion if they were 18 years and older and had an inpatient or outpatient colonoscopy procedure code in any facility within the Geisinger Health System during the period from January 1, 2002 to August 25, 2010. Data are presented as median and inter-quartile range, for continuous variables, and as frequency and percentage for categorical variables. Baseline comparisons across those with and without a perforation were made using the two-sample t-test and Pearson’s χ2 test, as appropriate.

RESULTS: A total of 50 perforations were diagnosed out of 80118 colonoscopies, which corresponded to an incidence of 0.06% (95%CI: 0.05-0.08) or a rate of 6.2 per 10000 colonoscopies. All possible risk factors associated with colonic perforation with a P-value < 0.1 were checked for inclusion in a multivariable log-binomial regression model predicting 7-d colonic perforation. The final model resulted in the following risk factors which were significantly associated with risk of colonic perforation: age, gender, body mass index, albumin level, intensive care unit (ICU) patients, inpatient setting, and abdominal pain and Crohn’s disease as indications for colonoscopy.

CONCLUSION: The cumulative 7 d incidence of colonic perforation in this cohort was 0.06%. Advanced age and female gender were significantly more likely to have perforation. Increasing albumin and BMI resulted in decreased risk of colonic perforation. Having a colonoscopy indication of abdominal pain or Crohn’s disease resulted in a higher risk of colonic perforation. Colonoscopies performed in inpatients and particularly the ICU setting had substantially greater odds of perforation. Biopsy and polypectomy did not increase the risk of perforation and only three perforations occurred with screening colonoscopy.

Keywords: Colonoscopic perforation, Colon cancer, Endosocopy

Core tip: This study is unique because we have used state of the art electronic medical records to collect information about risk factors which can predispose patient to a high risk of perforation. We have looked into multiple risk factors including but not limited to serum albumin, serum creatinine, body mass index (BMI), inpatient and outpatient colonoscopy and intensive care unit (ICU) patients. Limited literature is available about the above mentioned risk factors and there propensity to cause perforation. The important findings deduced from this research can have important implication in day to day practice of colonoscopy. The findings of Albumin, BMI, and Inpatient and out patient colonoscopy particularly performing colonoscopy in ICU setting predisposing to higher risk of perforation are crucial piece of information that can help physician in considering available alternatives which in turn may help to reduce the number of colonoscopic perforations.