**2. Bowel pathologies that increase the risk of perforation during small bowel endoscopy/enteroscopy**

Bowel pathologies with increased susceptibility for perforation during small bowel endoscopy include – Crohn's disease, anastomotic stricture, radiation stricture, altered surgical anatomy (ileoanal, ileocolic anastomosis), and intestinal lymphoma. The perforation rate during double balloon enteroscopy is seen more with the retrograde technique compared to anterograde [5]. Also, more perforations are seen with therapeutic procedures like polypectomy of large polyp (> 3 cm), argon plasma coagulation for AV malformations, and dilations of small bowel strictures [3, 5, 6]. Furthermore, endoscopy associated perforations are more in patients

#### *Endoscopy in Small Bowel Diseases*

with inflammatory bowel disease (IBD) as compared to non-IBD patients, with disease severity and steroid use being the two of the strong predictors for perforation [7–10]. In a systematic review, the total rate of perforation with enteroscopy in Crohn's disease was 4.27 per 1000 procedures (diagnostic and therapeutic procedures) and it was nearly 4 times that of diagnostic balloon assisted enteroscopy for all indications (1.1 per 1000 procedures) [11].
