PIG Meeting: 11th March 2021

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

Background

• 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

Issues

• 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.

Discussion

• 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

Plan

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

http://www.clinicallabs.com. https://www.clinicallabs.com.au/functional-pathology-old/practitioners/functional-tests-arterial/calprotectin-test/au/functional-pathology-old/practitioners/functional-tests-arterial/calprotectin-test