Colonoscopy after multiple cancellations

Gabrielle Morris

72-year-old man for colonoscopy via fast-track pathway following a positive FOB

Background:

  • +ive FOB in community. No new bowel symptoms noted
  • Initially planned for Cessnock hospital and was deemed unsuitable due to co-morbidities
  • Presented to Belmont on day of procedure and was cancelled due to co-morbidities. Had already undergone bowel preparation.
  • Notes form Belmont state “unsuitable for Belmont and possibly anywhere.’

Issues

  • Significant chronic health conditions.
  • Dementia. MMSE 4/15. Wife is man carer. Requires assistance with all ADLs
  • OSA – requires CPAP but can’t tolerate
  • IHD with 3 cardiac stents in situ
  • Episodes of VT – 2 ablations in past
  • Aortic regurgitation and mild pulmonary hypertension
  • AF, anticoagulated with DOAC
  • Significant orthopnoea, sleeps in chair
  • NIDDM with excellent control. On SGLT2 only
  • Noted to have raised CRP and ESR on perioperative bloods. WCC normal.

Discussion

FOB Pathway

  • Excellent program for early detection of bowel cancer in patients
  • Patients are fast-tracked to colonoscopy without seeing proceduralist in order to minimise delay
  • May not have been beneficial in this Complex patient. Surgical/gastroenterologist review may have identified the patient complexities/uncertain suitability for colonoscopy
  • Concerns expressed regarding cancellation on day of procedure after bowel prep. Not evident if plan in place to optimise/review patient prior to booking the colonoscopy at JHH

Should colonoscopy go ahead?

  • Patient likely not suitable for surgical procedure if cancer discovered on colonoscopy
  • May be able to have diagnostic or symptom-control procedure if required
  • Consider CT Colonoscopy? may be difficult with orthopnoea

Raised ESR and CRP

  • Not on any causative medications
  • Unlikely to have a new diagnosis of inflammatory bowel disease at 72
  • Consider discussion with gastroenterologist

Plan:

  • Discuss with surgeon regarding suitability of procedure
  • Gastroenterologist referral
  • If colonoscopy proceeds, may require admission to hospital for bowel preparation.
  • Pathway for referral of these complex patients between hospitals/perioperative clinics. Consider development of a referral pathway/guideline