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Perforations after routine biopsy in IBD patients, their management and potential risk reductions by microscopic imaging with endocytoscopy.

Biopsy-related perforation is a rarely reported complication of colonoscopy and controversy remains whether diagnostic biopsy confers also an increased risk for perforation in patients with inflammatory bowel disease (IBD) [1-3]. In this letter, as exemplified by a case report, we aim to raise awareness for biopsy-related perforations in longstanding ulcerative colitis (UC) even in patients without overt inflammation and at the same time provide an outlook on the potential of endoscopic techniques enabling real-time in vivo microscopy such as endocytoscopy (EC). Our patient was a 77-year-old male with steroid dependant pancolitis since 2002 and an increase in clinical activity; overall the Mayo Clinical Score (MCS) was 6. While high definition colonoscopy demonstrated a Mayo Endoscopic Score (MES) of 1, in vivo microscopic imaging using a latest generation endocytoscope (Olympus CF-H290ECI, Olympus, Japan) showed crypt distension and deformity along with LETTERS TO THE EDITOR