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 I² 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 (I² = 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.