Husband having transnasal endoscopy to check for varices

[Spooks58]

My husband has cirrhosis, portal hypertension, mild hepatic encephalopathy and ascites and is having an endoscopy next week to see if he has varices. How likely is this? If he does have them is the treatment good? He has stopped drinking and lost three stone since early June.

[AyrshireK]

Are you sure it's transnasal he's having the endoscopy? That's an unusual route - usually just upper gastric tract via the mouth.

My hubby first major symptom was a bleed from upper GI varices. If your husband has portal hypertension then there is a possibility he'll have varices hence the reason for checking.

The procedure can be a bit unpleasant, your gag reflex gets activated so it's advised to go for both throat spray and the sedation. Word of advise tell him to hold his breath as they do the throat spray to avoid gagging too much.

My hubby has had numerous endoscopies and had 42 varices banding. If they find varices suitable for treatment they might band them or treat with a type of glue. My hubbies varices have been eradicated after the 'aggressive banding regime' his consultant put in place.

If varices are present but not big enough for treating they might repeat the procedure in a few weeks/months time to keep an eye on them. They might also start prescribing a beta blocker which is specifically aimed at reducing the portal hypertension.

Katie

[Spooks58 in reply to AyrshireK]

Thanks, Katie. It's definitely transnasal which surprised me (I've had two gastroscopies via my mouth which were really grim). I've told my husband to have whatever sedation is offered. Do they band the varices when they do the endoscopy? Did your husband have beta blockers and if so did that help? Glad to hear the varices have been eradicated.

[AyrshireK in reply to Spooks58]

I wonder if it's something to do with covid precautions. My hubby had his latest endoscopy a couple of weeks ago and it was normal via the mouth and throat though everyone was fully gowned up and it was done in an operating theatre which was different. He was going every 5-8 weeks for banding with his. He's been all clear of needing banding since 2014 but has an annual endoscopy.

Some hospitals will band them there and then if they find them (I wonder how they'll pass a banding tool via the nose though as it has quite a bulky end). Unless in your hubbies case they'll do a look see via the nose and then deal with whatever they find in a follow up.

My hubby didn't have beta blockers as his liver specialist said they were no good for someone who had already had a bleed and preferred to go the banding route for eradication because he'd already had the massive bleed - hospitalization for 7 burst varices lead to his diagnosis of cirrhosis.

Katie

[cammeag in reply to AyrshireK]

katie, you seem to be the proper agony aunt on here. Well done on encouraging a few of us. I grew up in glasgow, but live in south east now. Where are you and your husband from?

david.

[AyrshireK in reply to cammeag]

We live in South Ayrshire, i've been her 30+ years moving here as a kid from Bolton, Lancs. Hubby is from NE England, Teeside and moved here after we met in 2010.

[cammeag in reply to AyrshireK]

I lived in Kilmarnock for a bit in my teenage years. Probably where I picked up my bad habits, along with a family history of alcoholism and my own selfishness ultimately. How is your husbands overall health? Is he well, exercising, sticking to his diabetic lifestyle? Hard for us northerners! I am now sixteen months in from my own liver failure. I got terrible mobility issues due to the odema smashing the nerves and blood vessels from my knees to the tip of my toes. I am ascites free now, though taking 225mg of spiro each night. Ive grown man boobs (sorry) through fatty deposits going on my pecs/chest whatever lol. Overall I feel that through prayer, lots, and getting as much info as I can, I’m feeling pretty much okay at the moment, I have a decent quality of life. Are you guys all okay? I am curious about the spleen therapy, removal, you mentioned as part of treatment. How have you stayed ‘in love’ through all this? If too personal don’t answer and I apologise. You devote a lot on here Katie, keep up the good work, I am always available at cammeag at hot mail and dot com if you ever need a sympathetic ear. I know we are not meant to give those details out but I already feel that I know you guys from your responses. All the very best in future days. David.

[AyrshireK in reply to cammeag]

Hubby does ok, he makes the most of good days. We both walk every day - at least a mile though before lockdown he'd been out on his own pushing himself to walk round local lanes - still went during lockdown because we are rural. Then he'll do walks of about 3 1/2 to upto 10 miles a day which is wonderful but he'll beat himself up because the former him used to participate in challenge walks - 100 milers in less than 48 hours and suchlike - he was a member of the Long Distance Walkers Association.

After a discussion with liver specialist dietician she said his blood sugars were only minimally over so only pre-diabetic rather than full on. I can't say he's eating much differently because he still has to have his carbs and snacks. We both cut out the sugar in our hot drinks and he switched to diet coke for the odd occasion he wants a fizzy drink and I buy some of the lower sugar varieties of foods. Dietician gave us great advice.

The spleen thing only came about because they discovered he had aneurysms in his splenic artery due to portal hypertension. His spleen was 19.5 cm at that point, platelets 22. Anyway they had to deal with the aneurysms as a rupture would have been fatal and they wanted it done before he was potentially transplanted so he wen through the embolization operation a week after t/p assessment. They went in through the artery in the groin and filled up the aneurysms with all sorts of wire work. It was immediately painful, both in his left side and left shoulder. We ended up going back through to Edinburgh for an emergency CT scan to see what was going on and it revealed he had suffered a splenic infarction which means the blood supply to the spleen had been almost totally blocked off and the spleen was dying. The spleen has shrunken now - I think at last ultrasound it was measured at 8 cm but it is classed as a non-viable spleen so it's function in the immune system now needs to be supported for life by a daily dose of Phenoxymethyl Penicillin. I don't think they intended to kill off his spleen but it did and in fact it had the beneficial effect of increasing his platelet count (last blood result we had was 200 for platelets and INR of 1) and he no longer has any portal hypertension - no banding of varices since the endoscopy before the embolization. In some countries I have read that they actually do partial embolization of the spleen as treatment for cirrhosis/portal hypertension.

As regards being in love, well we are best pals. I only met hubby when he was unwell so I don't know the previous version. We are a team, do everything together and support each other. We both have quite eccentric hobbies and met doing WW2 Battle Reenacting ( I am a reenactor for self-employment and teach all periods of history in schools across Scotland - dressed up in period costume). During lockdown the house has been a prop and costume design studio and there is always a project on the go. We hold hands, cuddle and just look after one another and really that's it. Bestest pals.

Katie

[PoppyPiper]

Hi, I have had 3 gastroscopies all via the mouth, the first I had the throat spray only and was OK, the 2nd one we had to abort as I just could not swallow the tube. 3rd I had the throat spray and was sedated and it went really smoothly, if I ever need to have another one I would go for the sedation every time. Only drawback was I had to attend my local hospital with my husband as you can't drive after. All were about 18 months ago before my transplant and like Katie have never heard of the nasal route.

- PP

[Kristian]

Hi Spooks,

With cirrhosis, portal hypertension, ascites and hepatic encephalopathy, the chance of them finding some varices when they look is probably quite high. Whether any treatment is needed will depend on the size of the varices and whether there are any signs that they are likely to bleed any time soon. If they are very small they may not need to do anything or prescribe any meds. If they are medium sized then the likelihood is they will start him on beta blockers, if they haven't done so already, but if they are large then they may consider banding if they think there is a danger they could rupture.

They will though go through all this with you when you go for the scan. Do feel free to ask them the question about whether they will band if they find them. I'm sure they'll be happy to explain.

Good luck and hope it goes well.

[jacobsmum24]

Well done to your husband for stopping drinking and on the weight loss. I had an endoscopy (not nasal) about 4 months after my cirrhosis and portal hypertension diagnosis. Three grade 2 varices were discovered but as they weren't bleeding I didn't require any banding. I started on Carvedilol and have been taking it for about a year now with no problems so hopefully it's doing it's job. I have not had a further endoscopy to check but at last ultrasound I was told portal hypertension had improved and backflow of blood had reversed so hopefully varices will remain under control without banding.

[TJB7]

Hi sorry to hear that your husband is suffering from all these complications.

He has exactly everything that I had, he may well have varicies as I did, but these never required any treatment as I only ever suffered a couple of minor bleeds, I was on blood pressure medication to lower the pressure in the portal hypertension. Obviously if during the endoscopy they find some varicies that have the potential to bleed they will deal with them there and then, and I doubt he'll even realize.

I would however like to advise how a traumatic event can lead to an acute episode of increased encephalopathy. This was something I'd never been made aware of. I've subsequently been advised that even something like minor surgery, procedures or even psychological trauma can trigger an acute attack.

I had been suffering from HE for almost two years and increasingly it got worse over time. The encephalopathy had affected every part of my life from being able to drive and even work, but with my husband's support we coped, even though most of the time I was acting drunk due to it.

We even put a tracker app on my phone in case I got lost. I sound like I was really bad but I did still function, however on a reduced level.

But I had one episode during a tooth extraction that tipped me over the edge and within the space of an hour I went from being able to get the bus to the hospital, find the department and understanding the procedure to acting like a total dementia patient.

The last thing I remember was the crack of the tooth then after that I don't remember a single thing, but apparently I couldn't find my way out of the department and when I eventually did, I was wandering the corridors unable to ascertain how to get out of the building.

(Considering I worked there this shouldn't have been an issue). I then found my way back into the dental department and sat down and fell asleep. They took me to an area of safety and rang my husband. Unfortunately over the next 24 hours I deteriorated further and was hospitalised for 10 days so the toxins could be removed using strong laxitives.

Even though I was discharged I continued to have a reduced cognitive impairment, which lasted until June this year, when I received my transplant.

So please accept my story as a heads up to look out for any cognitive changes following any medical/surgical or psychological traum.