Severe COPD, colonoscopy

Gabrielle Morris

Background

  • 81F for colonoscopy for altered bowel habit. Not anaemic.
  • Severe COPD, stable hypothyroidism, breast ca,

Issues

  • Appropriateness of proceeding:
    • Severe COPD, breathless with pursed lip breathing after walking along hallway to clinic room.
    • Known to Prof. Gibson, last correspondence suggests she is optimized.
    • Audible wheeze, sats 94% on RA.
    • Unable to shower self or make bed, DASI METS 3.97

Discussion

  • Most patients can tolerate a colonoscopy
  • If there was a complication (eg. aspiration) this would likely be terminal for this patient.
  • Correspondence from the gastroenterologist suggested he thought it very unlikely he would find anything. If cancer was found, the patient is unlikely to be fit for surgery. 
  • Discussion with gastroenterologist who agreed patient was extremely high risk and had been looking for consensus not to proceed. Mentioned that he had considered CT colonography as an alternative. This also requires prep but can be done without sedation and is much faster. Drawbacks are that it is diagnostic only, and may require subsequent colonoscopy.
  • Discussion about limited anaesthetic time available for endoscopy, and increasingly more patients requiring anaesthetic support. Should we be more judicious in considering the use of this resource when CT colonography is a reasonable alternative in some?

Plan

  • Patient referred back to gastroenterologist for a CT colonography.