Safety of Flexible Sigmoidoscopy in Pregnant Patients with known or suspected Inflammatory Bowel Disease

I. Background and Aims Lower gastrointestinal endoscopy is the gold standard for the diagnosis and staging of Inflammatory Bowel Disease (IBD). However, there is limited safety data in pregnant populations, resulting in conservative society guidelines and practice patterns favoring diagnostic delay. The aim of this study is to investigate if the performance of flexible sigmoidoscopy is associated with adverse events in pregnant patients with known or suspected IBD. II. 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 course, and lifestyle factors. Two independent reviewers performed the data abstraction. Adverse events were assessed for temporal relation (defined as within 4 weeks) with endoscopy. Any discrepancies in the two reviewers’ data were reviewed by a third independent investigator. Descriptive statistics of data were calculated, and comparison of continuous and categorical data were made using a one-sided Wilcoxon rank-sum test and Fisher’s exact test, respectively. III. 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% of patients experienced a change in treatment following sigmoidoscopy. 12% of the patients with known IBD were found to have no endoscopic evidence of disease activity despite symptoms. IV. 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.