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Safety of Flexible Sigmoidoscopy in Pregnant Patients with Known or Suspected Inflammatory Bowel Disease

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Abstract

Background and Aims

Lower gastrointestinal endoscopy is crucial in the diagnosis and staging of inflammatory bowel disease (IBD). However, there are limited safety data in pregnant populations, resulting in conservative society guidelines and practice patterns favoring diagnostic delay. We studied whether performance of flexible sigmoidoscopy is associated with adverse events in pregnant patients with known or suspected IBD.

Methods

A retrospective cohort study was conducted at the University of California San Francisco (UCSF) between April 2008 and April 2019. Female patients aged between 18 and 48 years who were pregnant at the time of endoscopy were identified. All patient records were reviewed to determine disease, pregnancy outcomes, and lifestyle factors. Two independent reviewers performed the data abstraction. Adverse events were assessed for temporal relation with endoscopy.

Results

We report the outcomes of 48 pregnant patients across all trimesters who underwent lower endoscopy for suspected or established IBD. There were no hospitalizations or adverse obstetric events temporally associated with sigmoidoscopy. 78% (38/50) of lower endoscopies performed in the patients resulted in a change in treatment following sigmoidoscopy. 12% (5/43) of the lower endoscopies performed in patients with known IBD showed no endoscopic evidence of disease activity despite symptoms.

Conclusions

Lower endoscopy in the pregnant patient with known or suspected IBD is low risk and affects therapeutic decision making. It should not be delayed in patients with appropriate indications.

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Acknowledgments

The authors thank the UCSF Academic Research Systems unit including Dana Ludwig and Boris Oskotsky for electronic health record database generation and management. They also thank members of the UCSF Division of Gastroenterology for valuable discussion and feedback on this work.

Funding

VAR was supported by the National Institute of Diabetes and Digestive and Kidney Disease of the National Institutes of Health under award number T32 DK007007-42. UM was supported by a senior research award from the Crohn’s Colitis Foundation of America.

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Author notes

  1. Myung S. Ko and Vivek A. Rudrapatna have contributed equally to this work.

Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, University of California San Francisco, Myung Ko. 1701 Divisadero St, Ste 120, San Francisco, CA, 94115, USA

    Myung S. Ko, Vivek A. Rudrapatna, Patrick Avila & Uma Mahadevan

  2. Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA

    Vivek A. Rudrapatna

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  1. Myung S. Ko
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  2. Vivek A. Rudrapatna
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  3. Patrick Avila
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  4. Uma Mahadevan
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Contributions

MSK was involved in conception and design, analysis and interpretation of data and drafting of article. VAR was involved in conception and design, analysis and interpretation of data and drafting of article. PA was involved in analysis and interpretation of the data and drafting of article. UM was involved in conception and design, critical revision of the article for important intellectual content and final approval of the article.

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Correspondence to Myung S. Ko.

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Ko, M.S., Rudrapatna, V.A., Avila, P. et al. Safety of Flexible Sigmoidoscopy in Pregnant Patients with Known or Suspected Inflammatory Bowel Disease. Dig Dis Sci 65, 2979–2985 (2020). https://doi.org/10.1007/s10620-020-06122-8

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  • DOI: https://doi.org/10.1007/s10620-020-06122-8

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