What are Oesophageal Varices?
Oesophageal varices are enlarged veins in the lining of the gullet. They are often caused by liver diseases but can have other causes as well. They are important to treat because they carry a risk of bleeding.
What is Banding of Varices?
It is possible to reduce the risk of bleeding from the varices by destroying them. One way of doing this is by applying rubber bands to the varices.
A gastroscope will be passed down into your gullet. The gastroscope is a long flexible tube (about the thickness of your index finger), with a bright light at the end. A special device will be attached to the tip of the scope. This device contains several surgical rubber bands that can be used to capture the enlarged veins and therefore reduce the risk of bleeding. It may take more than one treatment to ensure the varices are adequately managed.
Banding of varices in the gullet is the best and safest treatment if they have been bleeding or the doctor is trying to prevent them from bleeding. In severe or exceptional cases there are more complicated alternatives, which you can discuss with your doctor.
What are the risks?
As with all medical procedures there are some risks involved. The main risk of this procedure is creating a leak (perforation) through the gullet or stomach which occurs about 1 in 1500. If this occurs, an operation to repair the leak may be performed.
Other complications include risk of bleeding which is 1 in 100 after banding of varices. If this occurs a blood transfusion may be required.
Damage to teeth or crowns is possible although rare. In addition it is not always possible to complete the procedure, this may be because you are unable to swallow the tube or you have asked us to stop.
You should be aware that no test is 100% accurate and abnormalities can be missed, including cancers. You may wish to discuss this with the doctor or nurse who will seek your consent before the examination.
If you require sedation there is a small risk that the sedative may affect your breathing. We aim to reduce this risk by assessing your general health before the endoscopy and you will be closely monitored by qualifies nurses before and after the examination.
What should I do before my procedure?
If you have diabetes you should not take your diabetic medication whilst you are not eating food.
An endoscopy nurse will try to telephone you before your test, especially if you are taking diabetic medication, warfarin or clopidogrel tablets.
On the day of the procedure
To allow a clear view of your stomach it must be empty:
- Do not have any solid food or milk for six hours before your test
- You may have clear fluids up to two hours before your test
- If you are attending for an appointment after 5pm you must not have solid food or milk 10 hours before your test
It is important that you do not starve for longer than this, unless specifically advised by the doctor or nurse, to avoid dehydration.
On arrival in the endoscopy department, please give your name to the receptionist. Your appointment time is the booking in time, not your procedure time. We will try to start your procedure as soon as possible. You may wish to bring a book, newspaper or magazine to read as you wait. Delays can occur, this is mainly due to clinical reasons including emergency situations. We will try to keep you updated with any delays in the unit.
Before the test, you will be seen by a nurse who will go through the health questionnaire with you. A doctor will speak to you in a private area of the department before your procedure. This will give you the opportunity to ask any questions. You will then be asked to sign a consent form indicating you understand the nature and risks of the procedure. You are not required to change out of your usual clothing.
You will be asked whether you prefer a local anaesthetic throat spray or a sedative injection.
Local anaesthetic throat spray
The spray numbs the back of your throat to make it more comfortable to swallow the tube. You will be fully awake whilst the test is being performed. We will take you to recovery to monitor you for a short while to rest and recover. You can drive yourself home and carry on with your usual activities. You will not be able to eat or drink for one and a half hours after the test, until you can swallow as normal.
Midazolam
Midazolam is a conscious sedative injection which aims to make you feel relaxed. It is given through a small needle in your arm or hand and is given to you in the procedure room before the test begins. This is not an anaesthetic and you will be awake but the injection should relax you. You will be allowed to rest quietly in the recovery area where a qualified nurse will observe you until the main effects of the sedation have worn off. You must have someone to collect you from the endoscopy department and take you home.
Midazolam is a sedative which can affect your mental ability to think clearly for up to 24 hours after it is given, even though you may feel wide awake.
For 24 hours after the procedure you should not do any of the following:
- Drive a vehicle or motorbike
- Use kitchen appliances such as a cooker
- Have a bath unsupervised
- Look after children on your own
- Go to work
- Operate any potentially dangerous machinery
- Sign any legal documents
- Drink any alcohol
- Take sleeping tablets or recreational drugs
- Breastfeeding
If you have sedation you must have someone to collect you from the endoscopy department and take you home. You are advised to have someone with you for the next 24 hours, as your judgement will be affected by the sedative. We will not be able to give you sedation if you do not have a responsible adult to collect you and stay with you for 24 hours.
What should I expect during the procedure?
The nurse caring for you during the test will ask you to lie on your left-hand side on a trolley. If you have spectacles, hearing aids or dentures you will be asked to remove them for the test. Oxygen will be given to you by a small tube into your nose and a small plastic mouth guard will be placed in your mouth. A nurse will monitor your pulse rate and oxygen levels during the test.
During the test air is used to inflate your gullet and stomach to allow a clear view. The air is sucked out at the end of the test; however, you may get “windy” type symptoms and a sore throat. This will usually pass within 24 hours. If you get a lot of saliva in your mouth, the nurse will clear it using a sucker. When the test is finished the endoscope is removed quickly and easily. The test takes approximately 10 to15 minutes but it may take longer.
Does it hurt and will I be in much pain?
The examination may result in some abdominal discomfort due to the stomach being inflated with air. This discomfort should begin to settle once the procedure is finished.
After the examination
If you have been given the throat spray the endoscopy staff will speak to you immediately following your test. You will then be given written information about your test, including when you can next have a drink. Once you have this information you are free to go home or return to work. If you have had the relaxant injection you will be given your information after a short time in the recovery room and then allowed home in the care of a responsible adult.
How will I know the results of my test?
The endoscopist performing the procedure will often be able to give you some results after the procedure. Before you are discharged you will be given clear details concerning any follow up arrangements. A full report will be sent to your GP and your referring consultant.
Contact numbers
If you have any further questions, you should contact the following:
Queen Elizabeth Hospital (main switchboard) 0191 482 0000
Out of hours
Accident and Emergency 0191 445 2171
Endoscopy
Endoscopy Department
Queen Elizabeth Hospital
Sheriff Hill
Gateshead
Tyne and Wear
NE9 6SX
Monday – Friday
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