Cirrhosis of the Liver Community
Standard procedure for cirrhotics to have an endoscopy if hey are not b...
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Cirrhosis is the end result of chronic liver damage caused by chronic liver diseases. The purpose of the community is to share support and information with Cirrhosis of the Liver patients and their loved ones. Topics in the community include: causes, clinical trials, complications, family issues, living with Cirrhosis of the Liver, prognosis, research, surgery, treatments

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Standard procedure for cirrhotics to have an endoscopy if hey are not bleeding?

The liver clinic wants to do it though I haven't bled since being undetected.
I am not convinced it is necessary.
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446474_tn?1404424777
"The liver clinic wants to do it though I haven't bled since being undetected.
I am not convinced it is necessary."

Hi!

Yes it is very necessary. Until your cirrhosis and portal hypertension partiality reverse enough to reduce the blood pressure in your collateral veins (varices). Which can take months to years depending on have advanced your cirrhosis is and achieving SRV.

Being undetectable doesn't reserve cirrhosis or portal hypertension. When yo have been SVR for sometime than cirrhosis can partially reverse. So you still have cirrhosis and need to do prophylactic treatment like Nadolol for portal hypertension and general monitoring and maintenance of your cirrhosis. You are still prone to HCC (liver cancer) as well. Your varices still exist because portal hypertension still exists and if your varices were medium to large or you had wale marks, they can still hemorrhage.

Varices do not cause symptoms until they leak or rupture, leading to extensive bleeding. Signs of bleeding from varices can include vomiting blood, dark-colored or black stools, and lightheadedness. If bleeding is severe, the person may lose consciousness.

Bleeding varices require emergency medical treatment. If not treated quickly, a large amount of blood can be lost and there is a significant risk of dying. If one or more of these symptoms develop, the person needs to seek emergency care (ER).

Keep all cirrhosis maintenance as before until you are SRV and retested to show your portal hypertension has been reduced.

Makes sense?
Good luck!!!
Hector
17 Comments Post a Comment
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3097131_tn?1357088481
If you have already bled the first time,then yes it is Recommended to have a follow up every so often,I had read somewhere.You are at a Higher Risk after the 1st time.Life threatening also.

I am having the Endoscopy done to a possible Banding on 28th.I am GT1a, just 6weeks out of Treatments.I am not looking forward to it,but it is something that has to been done. I have heard of people that has had it done 4 or 5 times,HEY whatever it takes is what I am doing to Survive.

Best to You,
~Country
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3097131_tn?1357088481
I forgot to say this is my 1st time having this done,I have Cirrhosis and I have never Bledout before..I do know that it is very uncomfortable for awhile..I

I didnt realise who posted till after the 1st post I sent,you know all about that..LOL

Country
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Avatar_f_tn
I appreciate your reply. I don't really 'know all about it'...been kind of in denial.
Thanks and good luck to you.:-)
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446474_tn?1404424777
"The liver clinic wants to do it though I haven't bled since being undetected.
I am not convinced it is necessary."

Hi!

Yes it is very necessary. Until your cirrhosis and portal hypertension partiality reverse enough to reduce the blood pressure in your collateral veins (varices). Which can take months to years depending on have advanced your cirrhosis is and achieving SRV.

Being undetectable doesn't reserve cirrhosis or portal hypertension. When yo have been SVR for sometime than cirrhosis can partially reverse. So you still have cirrhosis and need to do prophylactic treatment like Nadolol for portal hypertension and general monitoring and maintenance of your cirrhosis. You are still prone to HCC (liver cancer) as well. Your varices still exist because portal hypertension still exists and if your varices were medium to large or you had wale marks, they can still hemorrhage.

Varices do not cause symptoms until they leak or rupture, leading to extensive bleeding. Signs of bleeding from varices can include vomiting blood, dark-colored or black stools, and lightheadedness. If bleeding is severe, the person may lose consciousness.

Bleeding varices require emergency medical treatment. If not treated quickly, a large amount of blood can be lost and there is a significant risk of dying. If one or more of these symptoms develop, the person needs to seek emergency care (ER).

Keep all cirrhosis maintenance as before until you are SRV and retested to show your portal hypertension has been reduced.

Makes sense?
Good luck!!!
Hector
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446474_tn?1404424777
Country you hit the nail on the head... "whatever it takes is what I am doing to Survive."


Cheers to you Country!

凸 (^_^)  凸

Hector
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Avatar_f_tn
Thanks so much Hector.
Pretty convincing.
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446474_tn?1404424777
I hope I was convincing. Or I might have to come over and take you to UCSF to see folks who thought they could get by with following up as they should have. It ain't pretty.

Always be complaint and close monitoring is always better then not. Having cirrhosis means we have certain commitments we must met or we can get into big trouble real fast.

That is why I have been on Nadolol for the last 4 years every day. I have squeaked by with no banding so far even though I have seen my varices go from small to large in the past 3 years. I have a good friend that had multiple bleeds. He almost bleed out a few times. Without his wife he never would have made it. He also had a few HE comas and got drained of fluid about every week. Whoa it is a miracle he is still alive. 4 year since transplant. Now he is treating his hepatitis C for 60 WEEKS!!! Man he puts me to shame. Well he is from the big apple so he is tough as nails anyway.

"An ounce of prevention is worth a pound of cure". When it comes to liver disease...Absolutely!

Thank goodness we still have healthcare. Nov 5th.
H
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Avatar_f_tn
:-). Well, Hector, I may run into you over there, one day.
I will see a Hepatologist there soon and once I am hooked up with someone I trust I will be totally compliant.
Thanks again.
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446474_tn?1404424777
A good hepatologist is (as the Mater Card commercial says) PRICELESS!!!

√v^√v^√♥
Hector
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1475202_tn?1388955435
Your not alone Rivll,
I am going in to Vanderbilt transplant center Monday for another routine endocopy, 3rd one since March 2010. My diagnosis is alcoholic cirrhosis, never had a bleed but with grade three varices it is important to monitor these vessels. As Hector stated a wale mark or cherry-red spot is an endoscopic sign suggestive of recent hemorrhage, or propensity to bleed, seen in individuals with esophageal varices. This preventative testing can play an essential role in saving your life. The procedure has always been completely painless and really only takes about 15 minutes.

Following that I will have a Ct Scan to monitor for HCC (liver cancer). This seems extreme since an Ultra sound will do but I have only had it done one other time in the begining. So I am excited to hear what the new results will bring although I would be greatful for nothing new to report!

Randy

Transplant center or not we all make mistakes. They had the CT with contrast scheduled two hours before the endoscopy. So I had to let them know to move the scan after the endoscopy since liquid (barium sulfate) is not allowed 12 hours prior to the endoscopy.


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163305_tn?1333672171
Yes. When I had cirrhosis my hepatologist wanted me to do an endoscopy. He repeatedly tried to get me to do one. I was in such denial, that I refused and only out of sheer luck, since I never had varicies, did it turn out alright for me.

You really don't want to start bleeding and wish you'd done the endoscopy earlier.        I had three post transplant and they're easy.
Nothing to worry about.
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Avatar_m_tn
Do you have any knowledge about Octreotide shots for the prevention of bleeding?  I am currently taking care of my husband with cirrhosis.  The doctor has said that his liver is just there now and his kidneys are not that great either.  He has been in and out of the hospital but we (husband and I) just are not ready to "make him comfortable."  I hate giving him those shots.  Just wondering if anyone has experience with this.
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446474_tn?1404424777
"In patients with suspected esophageal varices, octreotide can be given to help decrease bleeding. "
-------------------------------------------------------------------------------------------------
Am J Gastroenterol. 2009 Mar;104(3):617-23. Epub 2009 Feb 17.

Terlipressin vs. octreotide in bleeding esophageal varices as an adjuvant therapy with endoscopic band ligation: a randomized double-blind placebo-controlled trial.

OBJECTIVES:
Data are scarce on the head-to-head efficacy of terlipressin and octreotide as an adjuvant therapy to endoscopic management of variceal bleed. The aim of this study was to compare the efficacy and safety of terlipressin with octreotide as an adjuvant therapy to endoscopic variceal band ligation in patients with esophageal variceal bleeding.

CONCLUSIONS:
The efficacy of terlipressin was not inferior to octreotide as an adjuvant therapy for the control of esophageal variceal bleed and in-hospital survival. The length of hospital stay in the terlipressin group was significantly shorter but not of any clinical importance. The predictors of prolonged hospital stay were low hemoglobin, high pulse, prolonged prothrombin time, blood at nasogastric aspirate, and PSE."
----------------------------------------------------------------------------------------------------
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446474_tn?1404424777
Your husband is not eligible for a liver transplant?

He should still be taken care of at a transplant center even if he can't be transplanted. The kidneys can fail when liver disease is End Stage.

Has he and everyone given up?

Can you explain what the situation is so I can be of more help?

Hector
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1840891_tn?1383280315
This thread is making me nervous. I've been cirrhotic since at least 2004, but so far I've been fortunate in not having any problems with portal hypertension, ascites or varices. My hepatologist has not ordered any routine endoscopies. Is this okay? I pray that I don't need them, as I had one, along with an ercp, back in 2004, and I guess I must be an exception when it comes to endoscopies. It was a horrible experience for me. I have vague dream-like memories of struggling against the procedure, real memories of retching non-stop for hours afterward, and then when they finally gave me something to stop the retching I was so sedated that I couldn't stay awake long enough to get dressed. It scared my poor husband half to death when they made him take me home unconscious, but it was an out-patient facility and it was closed for the day long before they finally got me out of the place. I'm afraid the thought of having an endoscopy now induces a near panic reaction!
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Avatar_f_tn
I know how you feel. You make me feel a bit less of a wimp.
Every time I ask I hear a resounding " yes."  
But it does seem more doable than some other procedures
I was thinking all this time about can do and nygirl. They seem to  be back to normal lives.
Not sure what a normal life is anymore.
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1840891_tn?1383280315
Whew, I'm not the only one! Every time I read about how easy endoscopies are, I wonder what is wrong with me. I'm 8 weeks post EOT, and feeling better, but no, life is sure not normal again yet. I'm still looking forward to getting my life back again.
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