Feasibility of thin disposable endoscopes for screening and surveillance of gastro-oesophageal varices performed in outpatient liver clinic

Patients with liver cirrhosis who are scheduled to attend RAH Liver Clinic will be screened 4 weeks prior to their attendance. Patients who are due for their surveillance gastroscopy for gastro-esophagal varices will be identified by their treating physician and will be sent a signed letter of invitation. Patients who are interested in participating will be able to contact the researchers using an opt-in form and reply paid envelope. If no response is received following the initial letter, a single follow-up phone call will be made to confirm the patient’s decision for opt-in or opt-out. A follow-up phone call will be made 24-48 hours prior to the scheduled appointment to confirm whether the patient is agreeable to study participation. Subjects who agree to participate in the study will be asked to fast six hours prior to their attendance at the Outpatient department. Once the subjects are seen by the caring physician and the need for surveillance gastroscopy is confirmed, the subjects will be consented and un-sedated disposable ultra-thin gastroscopy will be performed in a dedicated room in the Liver clinic by an endoscopist. Procedure: The duration of the procedure is approximately 5-10 minutes. All subjects will be asked to complete the visual analogue scale for pain and State-trait Anxiety Inventory (STAI Y-1) score prior to commencement of the unsedated gastroscopy, which will be performed under laryngeal/pharyngeal local anaesthesia with lignocaine gargle or spray (10 minutes prior). On endoscopic examination, the following will be documented: 1. Number and location of varices: upper, middle or lower oesophagus or stomach. 2. Size of varices: classified according to Baveno I consensus, small varices < 5mm, large varices >5mm. [13] 3. Presence of red colour signs / red wale signs 4. Tolerability: to be assessed by pain visual analogue scale and State-trait Anxiety Inventory (STAI Y-1) form 5. Adverse events (3-min vital signs will be recorded).