27 April 2023

Whilst most of us with a bowel condition will have undergone one or more colonoscopies not so many have had upper GI endoscopies. Some conditions, including Crohn’s disease, can appear anywhere along the digestive tract, from mouth to the back passage, so it is sometimes necessary to examine the oesophagus, stomach and duodenum. That’s where the upper GI endoscopy or gastroscopy comes into play. I had one a couple of weeks ago. I’ll describe the procedure so you get an idea of what to expect. It followed the “usual” pattern and I feel qualified to define “usual” as this was my fifteenth, if you’re counting.

In this instance the consultant was not looking for inflammation but monitoring oesophageal varices. Think of them as varicose veins in my throat due to high blood pressure as a result of a clot in my portal vein. Why do I have a clot? The consensus of opinion is that it formed due to peritonitis following a perforated gut. The bit I struggle to understand is that my gut perforated in 1979 but the clot did not become apparent until 2012! How did it become apparent? I’ll leave that to the final paragraphs in case you are squeamish. Let’s just say it involved blue lights and the siren!

…and so, to the procedure. I had already been to Guy’s Hospital for a vedolizumab infusion that morning so took a leisurely stroll down to St.Thomas’, opposite the Houses of Parliament. My appointment was set for 1:00pm, the first slot after lunch. It’s worth arriving a little early as, quite often, appointments are booked in blocks of two or three and the running order is decided on a first come, first served basis. Unlike a colonoscopy there is no prep solution to drink. The only restriction is nothing to eat 6 hours before your appointment and nothing to drink 2 hours before.

My name was called and I was shown to a side room where a nurse attached a wristband, asked about current medication and allergies, and checked my blood pressure. Then there was THE question – “Are you having sedation?”. In the dim and distant past I had a gastroscopy without it. Never again! I can still remember the feeling as the endoscope passed through my mouth and down my throat. Nowadays I want to be away with the fairies until it’s all over. Choosing sedation requires a cannula which the nurse inserted into my right arm.

You will only be given sedation if you have an escort to take you home and have passed on their contact details so they can be called when you are ready for collection. You are not allowed to drive a car for 24 hours. With the formalities over I moved to the patient waiting area from where the doctor came to collect me and took me to the area outside of the theatre. Even though I had undergone the procedure many times before he still had to run through potential risks and get me to sign a consent form.

In the theatre I was welcomed by the team of three nurses each of whom introduced themselves. I got onto a trolley. A blood pressure monitor was placed around my arm and an oxygen supply inserted into my nostrils. This was followed by a Xylocaine spray to numb the back of the throat. For some reason it tastes of bananas but not just any bananas, burnt ones. Not very pleasant and just the thought of it used to make me gag. It has got easier with time. The final action was placing a camera guide between my teeth and getting me to roll onto my left side. All the preparations were complete by 1:35pm.

The consultant had filled a syringe with a cocktail of fentanyl and midazolam, connected it to the cannula and said “you’ll feel a little dizzy” as he injected the mixture. I remember thinking “I hope so…” and next I was waking up in Recovery around 3:00pm. I felt nothing after “…dizzy”. The nurse had good news. They had found nothing of concern and the procedure would not need to be repeated for another 12 months. Once I was sufficiently awake I was shown to the discharge lounge. After coffee and biscuits the nurse removed the cannula and went through the report. By then my escort had arrived and we were on our way home.

When I checked my phone later that evening I had a bit of a shock. There was a nicely lined up photograph of the endoscopic base unit. It was taken at 1:55pm. I was still under sedation at that point. I do not remember taking it. I found this Wikipedia entry which may explain it – “midazolam is superior to diazepam in impairing memory of endoscopy procedures”!

When writing a blog post I wrestle with what to include. Should all the gory details appear and run the risk of scaring readers about conditions they are unlikely to encounter? Can I appear too flippant which suggests that I do not take these issues seriously enough? I will leave those questions hanging but if you are squeamish or prone to hypochondria maybe stop reading now!

Oesophageal varices are nasty little things that have the ability to burst and leave you surrounded by a pool of blood. That’s what happened to me early one evening hence the blue lights and siren. They can easily kill you if medical help doesn’t arrive in time. They need to monitored and obliterated on a regular basis. If they find varices during a procedure the endoscope has a special attachment that draws up the offending varix and places a rubber band around it. Over the next few days the vein atrophies and the band drops off. This process is called band ligation or banding and is then repeated every four weeks until no varices remain. To be honest it is rather like living with a time bomb!

Postscript: After writing this post my “time bomb” exploded again and I found myself in our local A&E. After spending 14 hours on a bed in a corridor I underwent another gastroscopy and had four varices banded.  In a couple of weeks’ time I’m heading for endoscopy number 17.