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.