72-year-old man for gastroscopy and colonoscopy

Background

• Surveillance colonoscopy for previous benign polyps
• Gastroscopy for chronic GORD symptoms
• BMI 57
• NIDDM, good control
• PAF, on Apixaban
• Pulmonary Hypertension, routine echo in 2017

Issues

• Recent Bilateral PE’s (April 2021) with significant clot burden
• Admission with sepsis and AKI 2 months previously and DOAC ceased
• No investigations for OSA; STOPBANG 8 and Epworth Sleepiness Score 12
• Not known to respiratory physician and no follow-up in place from hospital admission

Discussion

Should procedure be postponed?

• Yes. Elective procedure. No red flags.
• Surgical team in agreement.
• Postpone until 6 months post PE.
• Postponement of 3 months is usually adequate. A longer timeframe was selected in this patient due to the severity of his disease and complex comorbidities.

Optimisation

• Referral to respiratory physician; significant clot burden, should he have repeat imaging before interruption of anticoagulation?
• Clinical suspicion of OSA (and possibly OHS) given multiple risk factors, ESS, and long-standing pulmonary hypertension.
• Plan to discuss with respiratory physician

Plan

• Postpone for at least 3 months
• Repeat echocardiogram
• Referral to respiratory team