Mukewar Saurabh, Costedio Meagan, Wu Xianrui, Bajaj Navkaran, Lopez Rocio, Brzezinski Aaron, Shen Bo
Departments of *Gastroenterology and Hepatology and †Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio.
Inflamm Bowel Dis. 2014 Nov;20(11):2056-66. doi: 10.1097/MIB.0000000000000154.
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.
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.
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).
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.
内镜检查相关穿孔（EAP）是一种可怕的不良事件，具有较高的发病率甚至死亡率。炎症性肠病（IBD）患者发生的EAP是否与更差的结局相关尚不清楚。我们旨在评估接受下消化道（GI）内镜检查患者的穿孔频率，并比较IBD患者与非IBD患者的危险因素及穿孔相关并发症（PAC）。
在这项病例对照研究中，我们确定了2002年1月至2011年6月期间发生下消化道EAP的患者。PAC定义为与EAP相关的死亡、结肠造口术的结肠切除术以及有/无转流造口术的肠切除术。在单变量和多变量分析中评估了29项人口统计学、临床、内镜和手术特征。
共进行了217,334例下消化道内镜检查（IBD患者9518例，非IBD患者207,816例）。纳入了84例发生EAP的患者。IBD和非IBD内镜检查的穿孔率分别为每10,000例手术18.91例和2.50例。59例患者发生了PAC（70.2%），4例（4.8%）死亡，55例（65.5%）进行了有或无造口术的肠切除术（结肠造口术的全结肠切除术3例；转流和二期吻合术的切除术28例；一期吻合术的切除术24例）。多变量分析显示，内镜检查时使用全身糖皮质激素与PAC风险高13倍相关（13.5 [95%置信区间，1.3 - 1839.7] P = 0.007），而未发现IBD与PAC风险增加相关（0.69 [95%置信区间，0.23 - 2.1] P = 0.52）。
IBD患者发生EAP的频率高于非IBD患者。内镜医师在为服用全身糖皮质激素的患者进行下消化道内镜检查时需谨慎。
