Endoscopies – what might I need to know?

SUE WEBZELL

Sue Webzell is Haemophilia Clinical Nurse Specialist at Hollywood Private Hospital, Perth, Western Australia

Considerations for people with bleeding disorders

At various stages in their life, people with bleeding disorders will need medical procedures to diagnose or assess health problems. A common procedure is a colonoscopy and/or gastroscopy. These are types of endscopy and are diagnostic procedures that examine the gastrointestinal (GI) tract for abnormalities such as ulcers, polyps, inflammation, or cancer.

Colonoscopies and gastroscopies are routine procedures for most patients, but for patients with bleeding disorders, such as haemophilia, they may require special precautions to minimise the risk of complications.

PLANNING AN ENDOSCOPY

As with any invasive procedure, management pre-, during and post-endoscopy should be planned through discussion with your haematologist and Haemophilia Treatment Centre (HTC), as the procedure can pose an elevated risk of bleeding. Management may involve treatment to prevent bleeding complications. What treatment is required, the dosage and if it is required after the procedure will depend on the severity of the bleeding disorder and the type of procedure and if biopsies or polyps are taken.

The specific plans required should then be communicated to your gastroenterologist and their team.

GASTROSCOPY

Gastroscopy (upper endoscopy), or oesophagoscopy, is a procedure used to examine the upper gastrointestinal (GI) tract, including the oesophagus, stomach, and duodenum. It is commonly used to diagnose and treat problems in your upper GI tract.

An anaesthetic spray may be used to numb your throat in preparation, a plastic mouth guard will be placed and then the endoscope will be passed into your mouth, down your throat and oesophagus, and into your stomach. The doctor can view the lining and take tissue samples, if necessary.

COLONOSCOPY

Colonoscopy is a procedure used to examine the lower GI tract (large intestine), including all of the colon and rectum.

A colonoscope is inserted into the rectum to visually examine the lining of the large intestine. It is commonly used for screening colorectal cancer, identifying inflammatory bowel diseases, and detecting polyps or abnormal growths.

To reduce bleeding risk, a minimally invasive approach should be adopted, limiting the need for biopsies or other interventions unless absolutely necessary.

Also, caution will be used when inserting and manoeuvring the endoscope to minimise damage to the lining of the GI tract.

However, if the doctor sees any suspicious-looking areas, they may do:

• A biopsy – removal of a small amount of tissue from the GI tract, the stomach, oesophageal, colon or rectal lining
• A polypectomy – removal of polyps for further examination.

Patients with bleeding disorders are at a higher risk of bleeding after these interventions, so pre-procedure administration of factor replacement therapy or desmopressin (DDAVP®), alongside tranexamic acid to promote clot stability, may be required.

PREPARATION

Specific preparation for your endoscopy will be given to you by your gastroenterology team and HTC. This will depend on the procedure you are to have. You may be required to have a gastroscopy, a colonoscopy or both in the same visit.

Preparation may include:

• Discussion with your gastroenterologist and haematologist to develop a safe plan for the procedure
• Stopping certain medications several days in advance
• Bowel prep to cleanse the intestines, which will often take several days to complete. This typically involves:
  • dietary changes
  • use of laxatives
  • enema
  • fasting
• Infusion of replacement factor concentrates/desmopressin (DDAVP®)/tranexamic acid
• You will probably be given a sedative before the procedure to help you relax.

AFTER THE PROCEDURE

Occasionally patients may experience minor bloating, gas, or cramping after the procedure, but most return to normal activities the following day.
After the procedure, you should monitor for signs of bleeding, such as blood in the stool (after colonoscopy) or vomiting blood (after gastroscopy).

Any signs of bleeding should be reported to your HTC.

Additional factor replacement therapy or tranexamic acid may be required after the procedure to prevent delayed bleeding for up to 5 days.

In some cases, patients may remain in a hospital setting for observation for a longer period.

You should plan to have someone drive you home.

JUST REMEMBER

• While endoscopies are a very safe procedure, bleeding disorder patients face unique challenges due to their increased risk of bleeding.
• Make sure your gastroenterologist is aware of your bleeding disorder and the treatment plan.
• Early pre-procedure planning is required. Inform your HTC sooner rather than later.
• Successful management relies on a multidisciplinary approach involving gastroenterologists, haematologists, haemophilia nurses and laboratory staff.

REFERENCES

1. Melvil. A flexible endoscope. 2017. Photo licensed under Creative Commons Attribution-Share Alike 4.0 International license.

FURTHER READING

Cancer Council. Endoscopy. Accessed 27 September 2024.
Mayo Clinic. Upper endoscopy. Accessed 27 September 2024.
Mayo Clinic. Colonoscopy. Accessed 27 September 2024.
Cancer Council. Colonoscopy. Accessed 27 September 2024.
Australian Haemophilia Centre Directors’ Organisation (AHCDO). Guidelines for the management of haemophilia in Australia. Canberra: National Blood Authority, July 2016. Accessed 27 September 2024.
MASAC recommendations for bleeding prophylaxis in bleeding disorder patients undergoing GI endoscopy. MASAC Document #261. National Hemophilia Foundation, 2020. Accessed 27 September 2024.