colonoscopy and endoscopy concerns

[Claybuster]

I am scheduled to have a colonoscopy and endoscopy in 1 week. My last colonoscopy was 8 years ago and the two colonoscopies before that found nothing but hemorrhoids ( all colonoscopies were pre CLL diagnosis in Oct of 2017). I have never had an endoscopy but I do have a cough that seems to start after eating. Because I have a high WBC of 115 and I take 10 mg of Xarelto daily for 2 bouts of DVT, the gastroenterologist was concerned about performing these two procedures. The gastroenterologist finally received authorization from my Cll doctor to proceed with these procedures after many phone calls and e mails. My CLL specialist did not feel the high WBC was an issue and said to hold the xarelto 2 days before the procedures. Neither my primary care doctor or my local Oncologist/Hemotologist would " sign off" that it was OK to perform these procedures because of the xarelto.

I am a little nervous about the gastro's concerns and thinking about cancelling my procedures. Unfortunately, to get a Colonoscopy or endoscopy appt. takes 3 to 4 months and I will have to go through the "sign off" process regarding the Xarelto, again. Other than the occasional cough and some bowel frequency there are no pressing issues.

I thought I should have these tests before I am ready for CLL treatment, which my Cll Specialist has projected to be in 1 to 2 years. Should I find a new Gastroenterologist and re schedule?

I am w & w 6 and 1/2 years. 70 years old.. ALC 110, RBC 4,27, Hemo 12.6, Plts 151, Neuts 2.32. Slightly enlarged spleen and small lymph nodes.

Just got over a bout with some type of upper respiratory disease , then a 2nd bout with COVID. I feel good now.

Mutated HGIV, 14 q deletion 2/18 translocation

[Justasheet1]

CB,

If it were me, I would have the procedure and hold the medication as instructed.

Jeff

[cajunjeff]

I have had a colonoscopy and an endoscopy in the past year or so. I am on acalabrutinib and paused it a few days for both procedures. I tolerated both procedures well, with really no problems.

I am not sure I understand what concern your gastroenterologist has with a high wbc count and having these procedures. I am no doctor, but I just dont see how having a high wbc adds any risk to either procedure. Your labs look pretty good for someone with cll to me. Pausing your blood thinner makes sense to me and I would imagine pausing blood thinners is routine practive for any procedure where bleeding is a risk.

If your gastroenterologist is ready to proceed, I personally see no reason to delay these rather routine and low risk procedures, if you need them now.

That said, I dont see any urgency to get these procedures done before you start any Cll treatment. Unless someone is high risk, colonoscopies are usually done about every ten years. You are about due to have one, might as well get it over with. Insofar as the endoscopy is concerned, I would have it if its needed now, but if I didnt need one now I wouldn’t have one just to get it done before Cll treatment. I had both these tests done while treating for cll. Good luck whatever you decide.

[MistyMountainHop]

I had an endoscopy about three weeks ago. I opted for a throat numbing spray.......I won't make that mistake again. Initially, I was offered an anaesthetic, I wish I had taken that.

It's up to you.......but I know I would have the anesthetic, next time.

The only good thing about it? It was over in a few minutes.

Good luck 🤞

[Agfar in reply to MistyMountainHop]

To reassure Claybuster, I had the throat spray for an endoscopy and found it to be fine for me. Everyone is different of course. Also, non CLL doctors can have different ideas about a high WBC. One haematologist told me that some non CLL doctors could have a panic attack when looking at WBCs, for no concern to him. I would think the knowledge you get from the test would be good to know.

[mrsjsmith in reply to Agfar]

Agfar that is so true. One of my very experienced GP’s sent me to Haematology for an urgent appointment because he was concerned about my high WBC. They were most amused and sent me home feeling rather embarrassed.

Colette

[LeoPa]

As far as the colonoscopy goes, the WAC method is more "pleasant"than the "pump the bowel full of air" method.

fg.bmj.com/content/10/2/194....

[littlesparro]

Make sure they do the endoscopy first !! 😀

[bennevisplace]

Your CLL doc is unconcerned about your WBC, fine, why would he/ she be. Your platelet count is also just in the normal range, so not really a concern with respect to the risk of uncontrolled bleeding during the upcoming procedure.

Your primary care doc, local onc and most importantly the gastro are concerned about Xarelto, which increases that risk. Ultimately it's the gastro, responsible for the conduct of the procedure, whose call this should be. If he/ she deems it safe based on the other specialists' input, you can go with it.

If an invasive procedure is thought to be unwise, you could opt for a virtual endoscopy + colonoscopy, i.e. a tailored CT scan and interpretation, which should identify large polyps/ tumours in the colon.

What they're hoping to i/d with an endoscopy IDK. In the UK your symptoms would just get you a prescription for a med in the "proton pump inhibitor" class.

All of the above is IMO, and I'm not medically qualified.

[Bluesinthenight]

Discuss with your CLL doc and gastroenterologist with reference to the Xarelto prescribing guidelines which address holding the drug for at least a day before and a some time after procedures. This is in the Janssen package insert containing drug information for specific situations such as medical procedures in which there may be some risk of bleeding. Your gastroenterologist can estimate the risk or bleeding, but holding the drug for a short period of time would entail a low risk of recurrent DVT. All must be balanced against the risk of not detecting a precursor of malignancy such as a polyp or other lesion in your GI tract. It's always a matter of weighing risk vs benefit, no matter what intervention or treatment is performed. But one intervention that does Not entail risk is discussing your concerns with the relevant health care providers.

[Claybuster]

Well, thank you for all the input! I had the endoscopy...nothing found but ectopic mucous in upper third of esophagus. I also had the Colonoscopy..... found nothing other than a 4mm sessile polyp on the decending colon. Awaiting biopsy results but guessing 3 to 5 years for next colonoscopy.