Endoscopy / Varices

[humbled]

Hi Everyone,

I'm scheduled to go for an endoscopy on Wednesday. Can anyone tell me his or her experience with the procedure? Does it hurt, how long does it last, etc.?

Also, are there symptoms for varices? What kinds of predictors usually act as a sign that one has varices?

Any information you could provide would be really appreciated!!

[bharrisrn]

Hi - common symptoms of esophageal varices are abdominal pain, dark stools, and vomiting blood. Varices are enlarged veins in the esophagus secondary to high pressures where the blood returns to the heart at the inferior vena cava - hepatic portal triad. An endoscopy is a relatively simple diagnostic study where a tube with a very small camera is passed through your mouth down your throat, with lots of medicine to keep you comfortable. It allows both diagnosis and if biopsy, ligation or cauterization is needed they will do it. This may be too much information but I am trying to keep it simple. I am a registered nurse and started Harvoni one week ago today. 11 more weeks to go! This is my second shot at treatment. New to the forum as of today. Bridget

[Soulrole]

Bridgette have had bright blood on my stools since being on harvonibut my CBC is always good excellent hemoglobin so they don't keep me in er. How important is CBC in diagnosing serious problems

[bharrisrn]

Bright red blood covering the surface of the stool means the bleeding is at or just above the anus. It is a common symptom and can be caused most commonly by an anal fissure (tear), hemorrhoids, diverticulosis or polyps. The further up the bleeding is, such as varices or an ulcer, the darker the blood will be in the stool - maroon or dark tarry stools - this blood has gone through the digestive track. A CBC (complete blood count) measures red blood cells (RBC), which carry oxygen;
white blood cells (wbc), which fight infection; hemoglobin, the oxygen-carrying protein in red blood cells; hematocrit, the proportion of red blood cells to the fluid component, or plasma, in your blood; and platelets, which help with blood clotting. A CBC is an important diagnostic measure for blood loss either from bleeding or hemolysis (when red blood cells are destroyed), infection or immunosuppression, and one measure, platelets, of the ability of the blood to clot. Hope this helps. Bridget

[Lynn K]

Hi Everyone,

I'm scheduled to go for an endoscopy on Wednesday. Can anyone tell me his or her experience with the procedure? Does it hurt, how long does it last, etc.?

Also, are there symptoms for varices? What kinds of predictors usually act as a sign that one has varices?

Any information you could provide would be really appreciated!!

I have had a total of 12 upper endoscopies. I had an initial in 2008 and was found to have grade 1 varicies so mild enlargement. I was rechecked 2 years later in 2010 and the varicies had enlarged to grade 2. I was checked again the following year in 2011 and not had grade 3 varicies that needed treatment. I was not able to take a beta blocker to reduce portal vein hypertension as the goal of taking a beta blocker to treat varicies is to reduce heart rate to around 60 beats per minute and my resting heart rate is already less than 60.

I underwent 4 upper endoscopies over the next 4 months to band the enlarges blood vessels so I would not experience the varicies bursting and having the risk of dying from blood loss. After that I was rechecked at 6 months post and have been checked annually ever since to monitor for any recurrence so far I have had none since 2012.

I have no memory of the procedures at all. They gave me a sedative and it was lights out. Sort of remember floating to the car and then my spouse drove me home where I slept off the sedatives and woke later and had some food no big deal for me anyway.

When I had the banding so done I did have some difficulty swallowing for a few days afterwards kinda feels like you have a chunk of steak stuck in your throat when you swallow especially when I ate a bagel big mistake lol.

If you have varicies and they are not bleeding you will not have any idea they are there. The predictor for the possibility of developing varicies is having liver cirrhosis and portal hypertension. But you can't tell you have portal hypertension it does not effect your general blood pressure. Varicies were described to me as being similar to varicose veins but inside your esophagus your swallowing tube. If you have large varicies as was said you could either vomit large amounts of blood or if it drains into the stomach it will become partly digested which you will vomit and will have the appearance of coffee grounds. If you have a varicies bleed it is a medical emergency as the risk of death is high from a varicies bleed.

I hope this answers your question let me know if I can be of any further help.

Just to add I was diagnosed with cirrhosis in Jan 2008 and it was 3 years later when I had developed serious varicies.

Good luck to you
Lynn

[Lynn K]

From the Mayo clinic

http://www.mayoclinic.org/diseases-conditions/esophageal-varices/symptoms-causes/dxc-20206459

Symptoms

Esophageal varices usually don't cause signs and symptoms unless they bleed. Signs and symptoms of bleeding esophageal varices include:

Vomiting and seeing significant amounts of blood in your vomit
Black, tarry or bloody stools
Lightheadedness
Loss of consciousness (in severe case)

Symptoms

Esophageal varices usually don't cause signs and symptoms unless they bleed. Signs and symptoms of bleeding esophageal varices include:

Vomiting and seeing significant amounts of blood in your vomit
Black, tarry or bloody stools
Lightheadedness
Loss of consciousness (in severe case)
Your doctor might suspect varices if you have signs of liver disease, including:

Yellow coloration of your skin and eyes (jaundice)
Easy bleeding or bruising
Fluid buildup in your abdomen (ascites)
When to see a doctor

Make an appointment with your doctor if you have signs or symptoms that worry you. If you've been diagnosed with liver disease, ask your doctor about your risk of esophageal varices and how you can reduce your risk of these complications. Ask your doctor about an endoscopy procedure to check for esophageal varices.

If you've been diagnosed with esophageal varices, your doctor is likely to instruct you to watch for signs of bleeding. Bleeding esophageal varices are an emergency. Call 911 or your local emergency services right away if you have bloody vomit or bloody stools.

Causes

Esophageal varices sometimes form when blood flow to your liver is blocked, most often by scar tissue in the liver caused by liver disease. The blood flow begins to back up, increasing pressure within the large vein (portal vein) that carries blood to your liver.

This pressure (portal hypertension) forces the blood to seek other pathways through smaller veins, such as those in the lowest part of the esophagus. These thin-walled veins balloon with the added blood. Sometimes the veins can rupture and bleed.

Causes of esophageal varices include:

Severe liver scarring (cirrhosis). A number of liver diseases — including hepatitis infection, alcoholic liver disease, fatty liver disease and a bile duct disorder called primary biliary cirrhosis — can result in cirrhosis.
Blood clot (thrombosis). A blood clot in the portal vein or in a vein that feeds into the portal vein (splenic vein) can cause esophageal varices.
A parasitic infection. Schistosomiasis is a parasitic infection found in parts of Africa, South America, the Caribbean, the Middle East and Southeast Asia. The parasite can damage the liver, as well as the lungs, intestine and bladder
Risk factors

Although many people with advanced liver disease develop esophageal varices, most won't have bleeding. Varices are more likely to bleed if you have:

High portal vein pressure. The risk of bleeding increases with the amount of pressure in the portal vein (portal hypertension).
Large varices. The larger the varices, the more likely they are to bleed.
Red marks on the varices. When viewed through an endoscope passed down your throat, some varices show long, red streaks or red spots. These marks indicate a high risk of bleeding.
Severe cirrhosis or liver failure. Most often, the more severe your liver disease, the more likely varices are to bleed.
Continued alcohol use. Your risk of variceal bleeding is far greater if you continue to drink than if you stop, especially if your disease is alcohol related.
Complications

The most serious complication of esophageal varices is bleeding. Once you have had a bleeding episode, your risk of another bleeding episode greatly increases. If you lose enough blood, you can go into shock, which can lead to death.

[humbled]

Thanks to all of you for the info!

My stool is normal, and I haven't really experienced any of the symptoms, save for the occasional abdominal pain (mild).

No sign of blood though.

My FS was 13.6, so I'm F3/F4 according to the chart. I'm really hoping and praying that there are no varices, as the banding procedure sounds very unpleasant.

Lynn, were you at early cirrhosis, when your varices were first discovered in 2008? If so, you didn't need to get them banded right away?

Part of me wishes they could sedate me with a different means besides IV - makes me very uncomfortable. 

[Lynn K]

I was being followed for years I had liver biopsies every 5 years. My 2003 biopsy was F3 and the Jan 2008 was F4 they said early cirrhosis at that time.

Varicies only require banding (assuming you can't take a beta blocker) when they are grade 3 or have red wale marks indicating they could burst and bleed. Mild and moderate varicies do not have this bleeding risk so they only action is repeat biopsy in the future. My first one as I said was grade one so the protocol was to wait 2 years. When mine increased to grade 2 the recommendation is to repeat in a year.

From my understanding if you had a bleed from varicies you would know there is nothing minor about a varicel bleed. We are talking about a siginigant blood loss.

My Oct 2014 fibroscan was 27 and my March 2016 fibroscan was 33


I doubt that with you having what sounds like borderline cirrhosis you will have a concerning result.

[humbled]

Endoscopy done! I got the sedative, and the next thing I remember I was waking up in the recovery room.

I don't have a sore throat at the moment, but a bit of pain in my stomach because they took a small biopsy with the endoscope.

A bit tired, too, but that's probably because I didn't sleep at all last night.

And other good news - no varices!!!

I can't tell you how much I appreciated your words of support - I read them before I went to the endoscopy clinic this morning, and they really helped to settle my spirit. I hope I can help others in the future as well.

[Lynn K]

Alright glad to hear procedure went well and especially no varicies! Really they do take time to form and once you are cured likely never will

[Philadelphia]

Super news - really happy to read it. Congrats!

[bharrisrn]

Great news! Happy everything went well for you and best of all no varices!

[FeltonSun]

Great news! Happy everything went well for you and best of all no varices!

Yep, it's always good to hear good news! I hope mine goes well too.