Gastroscopy and colonoscopy for Inflammatory bowel disease

PIG Meeting: 11th March 2021

64 year old lady for gastroscopy/colonoscopy and biopsy to exclude IBD


  • Chronic nausea and diarrhoea
  • Super-morbidly obese; BMI 68
  • RA – on infliximab and Methotrexate
  • IDDM – on multiple oral hypoglycaemic agents and 130 units of insulin per day.
  • HbA1c – 7.2
  • SVT – multiple hospital presentations.
  • SVT ablation abandoned on DOS due to increased BMI.
  • Declined for weight-loss surgery


  • High-risk patient and uncertain indication for procedure.
  • Discussion with proceduralist revealed that it is very unlikely to be IBD but should be excluded given her history of autoimmune disease.
  • Patient was offered faecal calprotectin test but would have to self-fund cost of $70 and cannot afford it.
  • Patient unwilling to engage with weight-loss or dietician services. Limited by finances and RA.
  • Declining optifast due to costs involved. Previous successful weight loss preoperatively with optifast.


  • Very unfortunate situation, difficult to build rapport with patient.
  • Poor compliance with optimization strategies makes it very difficult to perform procedures for this high-risk patient.
  • Poor compliance is the most likely reason she was declined for weight-loss surgery.
  • She feels let-down by the medical profession due to multiple cancellations
  • Confusion around the need for gastroscopy. This needs to be clarified with proceduralist


  • Proceed colonoscopy and biopsy with minimal sedation
  • Further discussion with proceduralist regarding gastroscopy and funding for faecal calprotectin.