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Hep C Discussion Forum -> General Discussion -> Yearly gastroscopies for cirrhotics
Post Info TOPIC: Yearly gastroscopies for cirrhotics
Tig


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RE: Yearly gastroscopies for cirrhotics
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Hi Matt, 

I've had two endoscopies done at the same time they performed the colonoscopy. The worst of the entire procedure was the prep for the colonoscopy. They require the consumption of cleanser starting early in the morning the day of the test. It followed a few days of a light diet. The concoction they require you to drink tastes so foul, I find it difficult to describe without using profanity. Lets just say it's awful, but very, very effective. Once the evacuation process begins, you learn very quickly not to try and out guess it. Best to have plenty of reading material in the bathroom, because you'll spend some time getting reacquainted with the room. Some doctors have you follow up the evacuation process with two saline enema's. I think they just want to polish up the colon for the fun to come.

When I showed up at the endoscopy center, they prep you by having you change into a gown with the back open (lol), start an IV and explain the procedure. Each time I've had mine done, they were performed under general anesthesia. It was an easy process, and nothing about the procedure I can tell you about. It's about as easy a procedure as you can have done imo. It took about 30-45 minutes at the most. There was no pain or discomfort afterwards. My doctor came in once I woke back up to tell me what was or wasn't found. I didn't have any colon polyps or esophageal varicies fortunately, so there was no need for follow up in either case. They required me to stay in a recovery room area until I was sufficiently awake and could count my fingers and toes, as well as tell them who the president was! Pretty easy procedure overall.

Tig



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Tig

68yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 9+ years!

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mallani


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Hi Matt,

A gastoscopy (endoscopy) is a simple procedure. You need to fast for 8 hours so the stomach is empty. The back of your throat is sprayed with a local anaesthetetic to stop the gag reflex, and then you swallow a thin flexible tube. It has a camera and light at the tip and is connected to a large LCD screen. It also has a tube so air can be pumped into the oesophagus and stomach, and another tube with a biopsy gun.

I have had most done with just local anaesthetic as I like to see whats going on, and the Endoscopist gives a running commentary. The squeamish may prefer a brief anaesthetic with an IV drug like Fentanyl/ Midazolam.

The lower oesophagus is checked for varices and changes due to reflux. After entering the stomach, air is pumped in and the instrument rotated so all the stomach lining can be seen. The tube is then passed into the duodenum, and ulcers etc are easily seen. Usually you can get to the third part of the duodenum. Any suspicious area can be biopsied.

The whole procedure takes about 10 minutes if it is straight-forward. It is easy money for Endoscopists!

You might have a slight sore throat for a few hours, and you need to wait 2-3 hours before you can eat (the local has to wear off). If you don't have the IV stuff, you can go home after an hour. I've had them on the way to work! Cheers.



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Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
Isiscat2011


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Hi Matt:

Malcolm can give you the technical info. but I had an endoscopy done almost 2 years ago and I don't remember a thing that happened.  They put me out and when I woke up it was over.  It was an outpatient procedure and it didn't take long.  As I recall my throat was a bit sore afterwards. Mine checked out fine.  

I had another fibroscan a couple of days ago and the reading was up a bit from 2 years ago so doc told me to have another endoscopy.  I'd just as soon skip it smile but I guess I better comply.  Also due for another MRI which I have every 6 months.

My INR, Bilirubin, and Creatinine levels are still within normal range. Platelets run about 90.  Alt and Ast both run about 100-110, and AFP around 70-80.

 

 



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Diagnosed in 2011, Incivek triple in 2011, tx discontinued, Genotype 1a, CT, VL 7mill, cirrhosis dx in 2012, age 67, waiting for new DAAs.
Matt Chris


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Hey Malcolm 

Great post and great motivator to all of us that have been putting off getting the test done.

Sounds like the test is a little annoying but does not last long. Can you or someone else describe the basics of what goes on?

matt 



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"And in the end, the love you take is equal to the love you make"

61 year old Geno type A1, F4 Cirrhotic, started 24 weeks on Harvoni 12-17-14 ,EOT-5 week = UND, 8-31-15 =UND , SVR-24 Baby YES! 
TazKat


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Malcolm the best with info. I even learned something new again.. smile



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TazKat Genotype 1A null responder x 3 riba & iterferon twice, relapsed from Incivek 2012 with only 12 weeks left to do. stage 4 mild cirrhosis 4/25/2014/ started sovaldi riba & interferon.. finished treatment 7/17/14  results 7/25  cleared..

 

 
Audreyanna


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Malcolm, that is the best news!!! Thanks so much for clarifying that. I never truly understood what cirrhosis meant without hepc. Thank you again!!!



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Audrey

 

55 y/o, GT 1A, 1.4 million UI, cirrhosis, low platelets, enlarged spleen, high LFTs. Failed tx x2. 12 weeks Sovaldi/Olysio. Undetected end of treatment and 4 weeks after EOT!
mallani


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Audrey: All cirrhotics will develop portal hypertension. That means increased pressure in the portal venous system. The severity varies widely. The main reason is narrowing of the portal vein branches by fibroblasts ( scar tissue). After SVR, the scar tissue is resorbed, the portal vein branches can dilate and the pressure decreases. This is why cirrhotics won't develop new varices after SVR, and existing varices may shrink. In my case, the early changes of portal venous gastropathy resolved. Scar tissue in the liver can resolve in many patients. It is still uncertain, but wide bands of scar tissue may not be completely resolved. In up to 80% of cirrhotics, liver cell regeneration occurs, and liver failure becomes unlikely. The risk of HCC remains but is significantly less. So overall, cirrhotics can reasonably expect a normal life span after SVR.

Greg: Betablockers (such as propanolol) have been used for a long time to lower portal venous pressure. Larger varices can be ligated with rubber bands etc.  For Grade 1 varices I wouldn't bother, as these are unlikely to bleed. You are on your way to SVR, and I would expect these varices to disappear. Get a repeat in a year and I hope I'm around to hear that they've gone. Cheers.

 



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Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
Huey


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I went to see Nurse Bell who has set me up with a CT Monday,, I have to pick up this prep Sat. at the Hospital Pharm and use it Sunday. We are looking into cysts as a cause of my mild pain and discomfort .  This should give us an idea as to the condition of my liver and if I have cirrhosis, If i do , then I should get a Gastroscopie yearly?    As for my liver test, Everything is in range and stable. VL still UND.



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  HCV Genotype 3a , now Psot-Tx was on S/riba. First VL was 5.8 mil on 7-5-13 then "und" at 3.8 weeks. 06/13/14 still und. off meds 3 days back on 7/29 Last pill 08/10/14 SVR+4

 
Groupergetter


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Thanks Malcolm, I just had my first upper endoscopy/gastroscopy a few weeks ago. The results sha owed low grade 1 varices in the lower third of the esophagus.  Also stated minimal portal hypertensive gastropathy in the gastric body.  The doctor doing the procedure didn't discuss treatment. Is there a recommended treatment be for these findings?   If I remain UND should this improve without tx?  You are a wealth of knowledge, it is greatly appreciated by all here.   Thanks    G 

Malcolm, this is a great thread, important information.  May save someone's life.  You are part of what makes this such a great forum.



-- Edited by Groupergetter on Friday 27th of June 2014 12:48:45 AM

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1b  Int/Riba relapse @ 48 weeks.  Stop tx Peg Int/Riba 12 weeks ill. Relapse S/O 6/23/14 :(   Started Harvoni 11/12/14  EOT 4/28/15.  EOT+4 UND :)  SVR! 8/4/15  :)     Thankful for every morning.
Audreyanna


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That's great news, Malcolm! I didn't realize the risk goes away after svr. I also have cirrhosis and am awaiting my 8 week test results from the olysio/sovaldi treatment. I was under the impression that the liver will just "deteriorate" much slower without the virus making it so much worse, as I thought it cant heal itself, being scar tissue. So is this svr even better than I realized? I still expected to have a shortened lifespan because of the extent of damage. Thanks and again congrats.



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Audrey

 

55 y/o, GT 1A, 1.4 million UI, cirrhosis, low platelets, enlarged spleen, high LFTs. Failed tx x2. 12 weeks Sovaldi/Olysio. Undetected end of treatment and 4 weeks after EOT!
mallani


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Hi Isiscat,

As Sara said, they are one and the same.

Cirrhotics are difficult to assess, as frequently there are no symptoms or signs, and Lab. values such as Albumin, INR, Bilirubin and Platelet count may stay stable. If you have a normal gastroscopy, you can relax as it means the degree of portal hypertension is not severe. Ideally the examinations should be done every year, at the same Clinic so any early sign of PHG can be detected. Portal hypertension will gradually increase over a course of ~5, 10 or 15 years. SVR will start reducing the portal venous pressure, independent from resolution of liver fibrosis.

Thanks for the good wishes.



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Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
Sara


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Congrats on no more gastroscopy procedures unless needed Malcom!  Thanks for the information - I am overdue for an upper endoscopy to check for varicies.  I'm calling tomorrow to make an appointment with my gastro doc. 

Kathy, so sorry to read about your friend who bled out and died.  It scared me into taking immediate action since I recently experienced blood pooling in my ankle.  At first I thought I just bumped my ankle and it was bruised but I now realize I need to have this checked to be sure it's not more serious.

I appreciate all the posts here, and especially feel grateful when I read something that makes that light bulb in my brain go on and the bells and sirens go off to take action.

Thank you both.



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Sovaldi/Olysio/Riba 2 week vl 16 4 week vl UND! EOT vl UND! EOT+12 SVR!  EOT+24 SVR!!

 
Jaded


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Isiscat2011 wrote:

Excellent news, Malcolm.  You have been not only an amazing source of information here but also an inspiration particularly to those of us who have cirrhosis.  Your story has given me even greater hope.

I am due for an endoscopy but may ask my physician about a gastroscopy as an alternative.  How do the two procedures compare?

 I believe they are one and the same. Had my 1st one 2 weeks ago...all was good thank god. I am early stage cirrhosis/asymptomatic.

 

http://www.patient.co.uk/health/gastroscopy-endoscopy



-- Edited by Jaded on Friday 27th of June 2014 01:55:36 AM

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64 year old EOT 10-28-15,SVR24 April 21 2016  ALT-12/AST-23 June '19 - fibroscan 6.9 F-0 July '19
Isiscat2011


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Excellent news, Malcolm.  You have been not only an amazing source of information here but also an inspiration particularly to those of us who have cirrhosis.  Your story has given me even greater hope.

I am due for an endoscopy but may ask my physician about a gastroscopy as an alternative.  How do the two procedures compare?



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Diagnosed in 2011, Incivek triple in 2011, tx discontinued, Genotype 1a, CT, VL 7mill, cirrhosis dx in 2012, age 67, waiting for new DAAs.
TazKat


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had mine in march. One of ny best friends died of the varcies issues,  she started bleeding out & clots formed from her ankle to her lung, to her liver..  everywhere. & it was really freaking fast.. that was two yrs ago. i think she wasn't getting checked as often as she should. have been.  i have egd thing every year..

 



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TazKat Genotype 1A null responder x 3 riba & iterferon twice, relapsed from Incivek 2012 with only 12 weeks left to do. stage 4 mild cirrhosis 4/25/2014/ started sovaldi riba & interferon.. finished treatment 7/17/14  results 7/25  cleared..

 

 
Huey


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Hay ,, That is great man, It is about time you posted something on here concerning yourself, You have been so busy helping others on this forum that you never seem to get any support from the rest of us...
We are all in the together Keep your stick on the ice. (Red Green Show)

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  HCV Genotype 3a , now Psot-Tx was on S/riba. First VL was 5.8 mil on 7-5-13 then "und" at 3.8 weeks. 06/13/14 still und. off meds 3 days back on 7/29 Last pill 08/10/14 SVR+4

 
mallani


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Hi cirrhotics,

I had my last gastroscopy today, and have been told I only need another one if I have problems. As I've now had 13 over the last 20 years, this is a relief.  My last one was in April last year under local, and I had some mild changes of portal hypertensive gastropathy. These have now completely resolved after SVR, so I assume my portal pressure has dropped. All good.

Yearly gastroscopies is an excellent way to monitor cirrhosis. Assuming the critical Lab. values don't change much, it gives a good indication of the degree of portal hypertension (which all cirrhotics develop). Because of past experiences with patients, I've always worried about oesophageal varices and bleeding- more so than actual liver failure.  Portal hypertensive gastropathy is due to engorgement of the gastric veins due to high portal vein pressure. It is easily recognised by the mosaic appearance of the gastric lining, with congestion and tiny bleeding spots. This usually occurs before gastric and/or oesophageal varices develop and can be treated. I've been very lucky not to have developed varices and now, after SVR, they shouldn't occur.  So, normal gastroscopy and colonoscopy, and just have the liver imaging next week. Cheers.



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Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
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