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Management of iatrogenic perforation during colonoscopy in ulcerative colitis patients: a survey of gastroenterologists and colorectal surgeons

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Abstract

Purpose

Patients with ulcerative colitis, a high-risk group for the development of colon cancer, undergo colonoscopy more frequently than the general population. This increase in endoscopic evaluation also exposes these patients to an increased risk of complications, including iatrogenic perforation. Our survey study aims to determine factors that affect the management choices for iatrogenic perforations for ulcerative colitis patients in remission and identify areas of consensus among general gastroenterologists, inflammatory bowel disease specialists, and colorectal surgeons.

Methods

An anonymous, cross-sectional survey was performed using an online platform. A matrix questionnaire posed five clinical scenarios with six management options for an iatrogenic perforation in ulcerative colitis patients with varying disease distribution, disease activity, and maintenance regimens.

Results

One hundred thirty-eight general gastroenterologists, 35 inflammatory bowel disease specialists, and 174 colorectal surgeons responded to the survey; 47, 41, and 23%, respectively, answered they did not feel comfortable managing perforations in ulcerative colitis patients in remission. We found the greatest concordance among gastroenterologists and colorectal surgeons in cases of perforation in ulcerative colitis with a history of dysplasia; the majority of respondents chose staged total proctocolectomy with ileal pouch anal anastomosis. We found discordance in decision making for ulcerative colitis in remission without dysplasia, with perforation occurring in colitis involved and uninvolved areas.

Conclusion

Our survey revealed that a significant fraction of gastroenterologists and colorectal surgeons are uncomfortable managing iatrogenic colonic perforations in ulcerative colitis patients. We have identified knowledge and practice gaps in defining the optimal management of iatrogenic perforations in ulcerative colitis patients.

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Author information

Authors and Affiliations

  1. Department of Gastroenterology, Lenox Hill Hospital Northwell Health, New York, NY, USA

    David DiCaprio, Burton Korelitz & Arun Swaminath

  2. Division of Colorectal Surgery, New York Presbyterian/Columbia, New York, NY, USA

    Steven Lee-Kong, Ahmed Al-Mazrou & RP Kiran

  3. Biostatistics Unit, Feinstein Institute of Research, New York, NY, USA

    Guillaume Stoffels

  4. Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA

    Bo Shen

Authors
  1. David DiCaprio
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  2. Steven Lee-Kong
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  3. Guillaume Stoffels
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  4. Bo Shen
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  5. Ahmed Al-Mazrou
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  6. RP Kiran
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  7. Burton Korelitz
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  8. Arun Swaminath
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Corresponding author

Correspondence to David DiCaprio.

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DiCaprio, D., Lee-Kong, S., Stoffels, G. et al. Management of iatrogenic perforation during colonoscopy in ulcerative colitis patients: a survey of gastroenterologists and colorectal surgeons. Int J Colorectal Dis 33, 1607–1616 (2018). https://doi.org/10.1007/s00384-018-3112-9

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  • DOI: https://doi.org/10.1007/s00384-018-3112-9

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