CREST Syndrome for Colonoscopy

garychleung

PIG Meeting: 8th April 2021

67-year-old lady, consult from gastroenterologist for a colonoscopy

Background

  • Positive Faecal-occult blood test
  • PET scan shows potential Right-sided lesion

Issues

  • CREST syndrome with Moderate pulmonary hypertension (on right-heart catheter)
  • NYHA class 4 dyspnoea
  • Attends Pulmonary hypertension clinic
  • Currently on a phosphodiesterase inhibitor, tried numerous other therapies without success
  • Significant co-morbidities including SLE and autoimmune hepatitis with liver cirrhosis (Childs-Pugh B)
  • Currently being assessed for home oxygen

Discussion

  • Consult letter states that the lesion appears low risk from the PET scan and there is the option to wait and repeat the scan
  • Discussion around suitability for surgery in the event of a cancer diagnosis from colonoscopy
  • Likely not a surgical candidate but many non-invasive options for cancer symptom-management
  • Consensus was that the option for a colonoscopy was available to this patient. Some opinions differed on any further optimisation for this surgery.

Plan

  • Multidisciplinary discussion required
  • Unclear if the proceduralist feels the colonoscopy is currently indicated or would prefer to wait
  • More information required before proceeding