International Journal of Colorectal Disease

, Volume 27, Issue 6, pp 811–816

Prevalence and risk factors for colonic perforation during colonoscopy in hospitalized end-stage renal disease patients on hemodialysis

  • Udayakumar Navaneethan
  • Sravanthi Parasa
  • Preethi G. K. Venkatesh
  • Bo Shen
Original Article

DOI: 10.1007/s00384-011-1400-8

Cite this article as:
Navaneethan, U., Parasa, S., Venkatesh, P.G.K. et al. Int J Colorectal Dis (2012) 27: 811. doi:10.1007/s00384-011-1400-8


Background and aims

Colonic perforation is a rare complication during colonoscopy. A recent single center study reported a high incidence of colonic perforation in end-stage renal disease (ESRD) patients on hemodialysis (HD) who underwent colonoscopy. We sought to determine nationwide, population-based prevalence in rates of colonic perforation during colonoscopy among ESRD inpatients on HD in the US, and to assess risk factors for colonic perforation in this patient population.


We obtained patient data from the Nationwide Inpatient Sample and used the International Classification of Diseases, the 9th revision, clinical modification codes, to identify ESRD patients on HD who had undergone colonoscopy in 2006. The control group consisted of inpatients who had colonoscopy without ESRD.


Colonic perforations occurred in 51/17,000 ESRD hospitalizations on HD (0.3%) and 3,951/564,428 controls without ESRD (0.7%). The risk of colonic perforation among the study group was not significantly higher than the control group even after adjusting for patient demographics like age, gender and comorbid conditions (adjusted odds ratio [aOR] −0.55; 95% confidence interval [CI], 0.30–0.97). Older age (OR −1.007; 95% CI, 1.002–1.011) and female gender (OR −1.18; 95% CI, 1.03–1.36) were identified as independent risk factors for the risk of perforation in this population group.


There appeared no increased risk of colonic perforation during colonoscopy among inpatients who received HD in our study. Increasing age and female patients appeared to be associated with procedure-related colonic perforation.


Colonic perforationColonoscopyEnd-stage renal diseaseHemodialysis



Charlson comorbidity index


End-stage renal disease




Healthcare cost and utilization project


Odds ratio


Nationwide inpatient sample

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Udayakumar Navaneethan
    • 1
  • Sravanthi Parasa
    • 2
  • Preethi G. K. Venkatesh
    • 1
  • Bo Shen
    • 1
  1. 1.Digestive disease Institute, Cleveland Clinic FoundationClevelandUSA
  2. 2.Department of EpidemiologyUniversity of WashingtonSeattleUSA