Are endoscopy procedures more risky for patients with very advanced liver chirhossis ?been reading the net last night said sedative risk.

[Countrywalks]

Can anyine say if its more dangerous to have endoscopy with very advanced aloholic chirhossis ?. What sedatives do they use and do you stay in the hospital over night ? was there pain afterwards if you got banded ?.ive been reading info off the net been having panic attacks since if anyone could help i would appreciate it .

[AyrshireK]

No need to label it alcoholic cirrhosis. Once it's cirrhosis it is cirrhosis regardless of cause.

As with all procedures there is always some degree of risk and before your procedure they do read out or give you a form that goes through some of the risks. Having said that my hubby has had almost 30 endoscopies since his diagnosis of cirrhosis in April 2012 many of them with banding (42 bands applied to date and varices largely obliterated) and apart from one where we know he struggled all have gone smoothly although he does have terrible anxiety about them.

Sedation generally Xylocaine (throat spray) and then a mix of Fentanyl & Midazolam by IV. This is very short lasting. Procedure lasts less than 10 minutes (total) and then you sleep the sedation off for a couple of hours. It is still in your system for 24 hours when you arn't allowed to drive, work machinery and they say you need some one with you.

My hubby generally has his endoscopy about 9am (first on the list most of the time) and we leave the hospital at the back of 12pm after he's had a snooze and then they make sure you can eat and drink before discharge. He then often sleeps much of the afternoon as he remains a little groggy.

If you have had banding a soft diet is advised for the next few days as there is a degree of discomfort as anything soft/solid or liquid passes the banding site - imagine food hitting a mouth ulcer !! Hubby does wince as food passes banding site. The longest his pain lasted was about 8 days - normally about 3-4.

** One big trick that hubby learned and which has served him well with all subsequent endoscopies going smoothy - Hold your breath when the throat spray is applied, tell staff of your anxieties and make sure they give you time to hold your breath that way your gag reflex is then not already activated. Hubby just shuts his eyes and sedation does the trick, he's back on the recovery bit in minutes - sometimes more awake than others but always surprised it's over and done with so quickly. **

The calmer you can be, the better the sedation works and it's over before you know it.

Good luck. Not the most pleasant of procedures but extremely necessary, my hubby wouldn't be here now without it after his diagnosis only came about after a massive upper GI bleed from burst varices.

Katie

[Countrywalks in reply to AyrshireK]

Thanks so much for your reply your husbands been through a lot by the sounds of it bless him. I read some scary stuff on the net so wanted an opinion off some one first hand .the whole varacie thing sounds scary .thanks judy

[AyrshireK in reply to Countrywalks]

He has and still is sadly. His cirrhosis is due to auto-immune liver disease and sadly had already advanced to late stage ill health before it was detected. He is being monitored now to see where we go from here.

[Countrywalks in reply to AyrshireK]

Right i see does he have much pain ? how on earth do you cope ?..how long ago was he diagnosed ?. But a transplant is hopefully on the cards ?

[AyrshireK in reply to Countrywalks]

No pain ever from liver area, we just muddle on, diagnosed April 2012 and at the moment no transplant isn't on the cards - he was listed in 2014 but is considered stable at the present time so was delisted. No major symptoms but lots of the associated niggles - mild HE, no libido, lack of energy, lack of drive, ability to concentrate decreased etc. We try and make the most of each day and keep an eye out for any sign of worsening. Sadly currently waiting for an MRI scan because something showed up in his last ultrasound so that's causing anxiety at the present time. Not a jot he can do to reverse his condition just eat well and stay as fit as possible.

[Countrywalks in reply to AyrshireK]

Ohh i see so he must be compensated then thats a relief for the moment but it must all be a big worry and stress for you both . Its awful how this disease can strike anyone . Yes enjoy each day sounds a good idea .

[Hidden in reply to AyrshireK]

I know your story so well, as having travelled the same way.

I am now post transplant and I pray you stay on my route!

[Hidden]

Hey Countrywalks. There is an alternative it's called " Capsule Endoscopy". You basically swallow tiny pill that has a camera in it and it reports the reading through little sticky patches attached to your abdomen. There is also a CT endoscopy alternative. Ask your doctor about the alternatives and see what they say. But as we have discussed on the forum here before you have no indicators other than your own self diagnosis that you have advanced cirrhosis. Hopefully the endoscopy will shed more light on this for you.

[AyrshireK in reply to Hidden]

There is no alternative to the regular upper GI endoscopy when it comes to the detection and treatment of varices.

[Countrywalks in reply to Hidden]

Thanks but are those just too look inside ? You cant band with those can you ?. Yes i know you said.

[Hidden]

Katie has covered everything for you. If it is your first time, then just be aware that it is possible to feel uncomfortable afterwards as they pump air into you to enable them to see the veins better. This can leave you with a feeling of trapped wind and it is best to take painkillers (although check this okay first with the person doing the endoscopy) to get rid of this pain as I found the pain horrible one time. I have had several endoscopies and generally the waiting is worse than the actual thing. Good luck

[Countrywalks in reply to Hidden]

Thanks yes katie seems very informative .but sureley you cant take pain killers if you have severe liver problems tho that would make it more complicated ?.

[Hidden in reply to Countrywalks]

People with cirrhosis get ill with things other than the liver. How insane would it be if they were never allowed painkillers?! You could break a leg or get a hernia etc etc. You are allowed painkillers, but NSAID's- anti-inflammatories such as ibuprofen etc are advised against. You can't take painkillers every day indefinitely, but you are allowed them for pain relief. If you want to check out the dosage and for how long, then it is best to ask your GP/ gastro/ hepatologist for advice. Also get a list of what you are allowed and not. The painkiller advice was for after the procedure not before

[Countrywalks]

Ohh right i see would that apply to decompensated chirhhossis tho ? Just asking .

[Countrywalks]

Yes it does .you must of had severe pain to have morphine .

[Countrywalks]

Im sorry to hear that it must of been awful im so sorry .was this at the begining of your illness ?.

[Hidden]

Thank-you for your concern. I wish you well with your own medical journey.

[Brett11]

I though most pain killers were based on morphine?

[Hidden in reply to Brett11]

Not aspirin or paracetamol. Tramadol is an opiate, but I don't know if that means it has the same active ingredient as morphine- not a pharmacist!! Not sure what your point is? Have I missed something?

[Brett11 in reply to Hidden]

No nothing. I just thought they were all opiate based.

[Hidden in reply to Brett11]

Hi Brett 11. Your question really got me thinking about painkillers as I had never thought of them being based on morphine, so I did a little research. Codeine is a derivative of morphine and chemically almost identical. Tramadol is classed as a codeine analogue, meaning that it behaves in a similar way to codeine. However, structurally they are very different, so it is not based on morphine, even though it does behave as an opiate. Hope this clears that up

[Garyvh]

Have you actually got an appointment for the procedure? If not, I do hope you're not worrying unecessarily about what ifs...

But, yes, they are carried out on decompensated patients, though in my personal experience at least, an ultrasound scan would come first, to look for any obvious signs of liver damage and portal hypertension, before they decide if any further procedures might be warranted.

As for the endoscopy itself, it's a bit unpleasant but not overly so. With the numbing spray and the sedation you don't feel much, if anything, and it's all over in a jiffy. Then they put you in a recovery room for half an hour or so, give you a sandwich and send you on your way (hopefully rejoicing).

The recovery room isn't like intensive care or anything, they just wheeled me through on the trolly I'd had the procedure on and wait for the sedatives to wear off.

I had a canula in, and the anaesthetist is present during the whole thing so they can keep adjusting the dose depending on how you are doing. I'd imagine that if you are really distressed they will just put a bit more into you. Upto a limit of course.

On a scale of, say giving birth, to say, having your teeth scaled, it's probably not even as bad as having your teeth done!

Gary

[Hidden in reply to Garyvh]

Great post Garyvh. They wont do an endoscopy on a patient for no reason. This person doesnt have decompensated cirrhosis nor a diagnosis of liver disease at all currently. That would need to come first with some indicator of portal hypertension to warrant doing an endoscopy.

[Radnor]

Perhaps look at it from a different angle? My brother needed an endoscopy but didnt wish to to be unable to drive/work after such a short procedure. He went in 'blind'. They didnt ask about his gag reflex. This was the problem he encountered! He gagged so hard his front tooth was snapped in half, his tum was wrenched unbelievably! He later developed a hernia and had to have his tooth crowned. Paid for by the hospital.I have NASH, I am on Buprenorphine patches which takes the top notes of arthritic pain. I have never had an endoscopy without sedative, my brother hasnt since. Everyone is different re liver disease but there are so many uplifting stories on here of people who have never been cast aside and given up on. It seems the people who lose the battle are the ones who cannot beat their alcohol addiction. Stop beating yourself up , 80% of heavy drinkers don't get cirrhosis. only 2/3% get it from methotrexate ie me! Not Drank for 15 years ,just went off it.I'm fighting a different addiction at present - sugar! I need to lose more weight to lose fat on my liver. I'm not unique on here, there is a lot of us lol. Anxiety and panic attacks are real, You need to discuss this with your GP. If they are not sympathetic, find one who is. Avoid Dr Google too. Its pointless anyone saying to you dont worry too. Like depression, mental health affect 1 in 4 people at some point in their life. Alcohol is used because people self medicate . Unfortunately they are unaware that alcohol is a depressant. If you have stopped drinking, your concerns and worries may be now revealing the cause of why you drank.Your GP needs to address this for you, hopefully it will help you while you get a diagnosis. I had no idea fibrosis was serious! I only found out when I went to re new holiday insurance. ! I suppose I am the extreme opposite of you. No to people on here are exactly alike, there are so many different causes of liver disease and different add ons. If you can resolve your anxiety it will help you see things more clearly. Hazelx