Factors associated with perforation related to diagnostic balloon-assisted enteroscopy: analysis of a national inpatient database in Japan

Background and study aims: Balloon-assisted enteroscopy (BAE) is a well-established procedure that is used worldwide for investigation of the small intestine. Previous reports describing the factors associated with perforation related to diagnostic BAE were limited by inclusion of only small numbers of patients who were mostly treated at a few specialized centers. The aim of this study was to clarify the factors associated with perforation by analysis of a large multicenter database. Patients and methods: This study retrospectively analyzed data from the Diagnosis Procedure Combination database in Japan. Patients who underwent diagnostic BAE between July 2007 and March 2013 were included. The primary outcome was the occurrence of perforation requiring open surgery. Logistic regression analysis was used to identify factors associated with perforation. Results: A total of 29 068 patients who underwent diagnostic BAE during the study period were identified. Perforation occurred in 32 patients (0.11 %). Univariable logistic regression analysis showed that patients with inflammatory bowel disease (IBD) on steroids had a significantly higher risk of perforation (odds ratio 8.55; 95% confidence interval 2.87-25.5; P<0.001). Non-IBD patients on steroids had an approximately threefold higher risk of perforation compared with patients who were free from IBD and not taking steroids. Conclusion: Our results suggest that patients with IBD who are using steroids have the highest risk of perforation related to diagnostic BAE.