Is Inflammatory Bowel Disease a Risk Factor for Perforation During Diagnostic Colonoscopy? A Systematic Review and Meta-Analysis.

PURPOSE

Inflammatory bowel disease (IBD) may predispose patients to complications during colonoscopy, including colonic perforation. This systematic review and meta-analysis aimed to determine whether IBD is associated with an increased risk of colonic perforation compared to non-IBD patients during colonoscopy.

METHODS

We systematically searched MEDLINE, PubMed, and Embase from inception to June 2025 for studies comparing rates of colonic perforation during diagnostic, screening, or surveillance colonoscopy in IBD versus non-IBD patients. A random-effects meta-analysis was conducted to calculate pooled odds ratios (ORs), with between-study heterogeneity assessed using I statistics. Risk of bias was evaluated using the ROBINS-E tool.

RESULTS

Across eight retrospective cohort studies comprising over 9 million patients (686,258 with IBD), the pooled OR for colonic perforation in IBD patients during colonoscopy was 1.22 (95% CI 0.89-1.68; p = 0.2199), which did not reach statistical significance. Heterogeneity was high (I = 82.1%). Subgroup analysis for ulcerative colitis and Crohn's disease demonstrated a pooled OR of 1.05 (95% CI 0.32-3.40) and OR 1.16 (95% CI 0.71-1.92) respectively. Only one study was judged to have a low risk of bias across all domains.

CONCLUSION

A diagnosis of IBD (either ulcerative colitis or Crohn's disease) is not significantly associated with an increased risk of colonic perforation during colonoscopy. Subgroup differences, study heterogeneity, and methodological limitations suggest a need for further research to better quantify this risk and guide procedural planning in IBD patients.