Medical Oncologist
CION Cancer Clinics
Who needs an endoscopy to check for varices? | CION Cancer Clinics
Most people with cirrhosis are offered an endoscopy to look for varices, unless their tests show the risk is low. People with liver cancer are often checked at diagnosis and before certain medicines. Varices cause no symptoms until they bleed, so this check finds them early. This page explains who is checked, what happens on the day and what each result leads to. At CION Cancer Clinics, our team supports patients and families through symptoms, follow-up and life during and after treatment.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed October 2026, next review due October 2027
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On this page
- Who should have an endoscopy to look for varices?
- Which situations lead a doctor to ask for an endoscopy?
- What actually happens at a varices endoscopy?
- What happens after each kind of result?
- What worries stop families agreeing to the test?
- What can this page not tell you?
- Common questions about endoscopy for varices
The short answer
Who should have an endoscopy to look for varices?
Most people with cirrhosis are offered an endoscopy to check for varices, unless their scans and blood tests show the risk is low. People with liver cancer who are about to start certain cancer medicines, or whose tumour affects the portal vein, are usually checked too.
Why anyone looks before there is a problem
Varices are swollen veins in the food pipe and stomach. They form when a scarred liver raises the pressure in the portal vein, the vein that carries blood from the gut into the liver. They cause no pain and no symptoms. The first sign can be vomiting blood. An endoscopy finds them while there is still time to treat the large ones, so a bleed is less likely. Read why liver disease causes varices for the background.
What an endoscopy is
A doctor passes a thin, flexible tube with a camera through your mouth into the food pipe and stomach. It shows the veins directly. If large varices are found, the same doctor can often tie them off with tiny rubber bands during the same test. That is called banding.
This page is for people with cirrhosis or primary liver cancer. If cancer has spread to a healthy liver from another organ, a varices check is not usually needed.Who is usually checked
Which situations lead a doctor to ask for an endoscopy?
Your hepatologist or oncologist weighs your own results. These are the common reasons the test is recommended.
Cirrhosis has been diagnosed
When cirrhosis is first found, doctors decide whether you need an endoscopy now or whether your results are reassuring enough to wait. If varices are absent or small, the check is usually repeated later.
Liver cancer has just been diagnosed
Many people with liver cancer also have cirrhosis. An endoscopy at diagnosis helps the tumour board plan safely. See endoscopy at diagnosis.
Before certain cancer medicines
Bevacizumab, used with atezolizumab in one common combination, can raise bleeding risk. Doctors usually want an endoscopy, and any large varices treated, before it starts. Read why you need an endoscopy before bevacizumab.
Signs that the pressure is high
- A low platelet count or an enlarged spleen
- Fluid in the abdomen (ascites)
- A tumour or clot in the portal vein on a scan
- A stiff liver on a FibroScan reading
Not sure whether this applies to you?
Ask an oncologist
!
Do not wait for a planned endoscopy if bleeding starts
If someone with cirrhosis or liver cancer vomits blood or something like coffee grounds, passes black tarry stools, or becomes pale, faint or confused, call an ambulance or go to the nearest emergency department now. Do not wait for the booked appointment, and do not travel to another city first. Tell the staff about the liver disease. Read vomiting blood: call an ambulance now.
On the day
What actually happens at a varices endoscopy?
Before you go
You will be asked not to eat for some hours beforehand. Tell the team about every medicine you take, especially blood thinners, and bring your latest blood reports. Bring an adult who can take you home.
Numbing or sedation
The throat is numbed with a spray, and many people are given a sedative through a vein so they feel relaxed and sleepy. The team chooses carefully, because a cirrhotic liver clears sedatives slowly.
The camera
You lie on your side. The doctor passes the tube gently and looks at the food pipe and stomach. The look itself is usually short. You may gag briefly, but you can breathe normally.
Banding, if needed
If large varices are seen, the doctor may band them during the same test. Your chest may feel sore and swallowing may be uncomfortable for a few days afterwards. Read about banding.
Results and next steps
You are usually told what was seen on the same day. The written report goes to your hepatologist and to the CION team planning your cancer treatment.
Side by side
What happens after each kind of result?
What the endoscopy shows
What usually follows
No varices
A repeat check later, at a gap your doctor sets from your liver function
Small varices, no warning marks
Closer repeat checks, and sometimes a beta-blocker tablet
Large varices, or red marks on them
A beta-blocker tablet, banding, or both, decided by the hepatologist
Varices in the stomach
A separate plan, as these are handled differently
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Commonly believed
What worries stop families agreeing to the test?
"He has no symptoms, so the test is unnecessary."
Varices give no symptoms until they bleed. The whole point of the check is to find large ones before that happens, while treatment is simple and planned.
"An endoscopy will make the veins burst."
A routine look is very unlikely to cause a bleed. The doctors doing it handle varices often and know how to manage them. The bigger danger is not knowing they are there.
"An ultrasound already showed everything."
An ultrasound or CT can hint at high pressure, such as a large spleen. It cannot reliably show the size of the veins inside the food pipe or the red marks that predict bleeding. Only an endoscopy does.
"Cancer treatment should start first. Varices can wait."
The two are planned together. With some medicines, checking and treating the veins first is what makes the cancer treatment safer to give.
Being straight with you
What can this page not tell you?
It cannot tell you whether you personally need an endoscopy now, or how often to repeat it. Guidelines differ in the detail, and your doctor looks at your platelet count, liver stiffness, liver function and cancer plan together. Some people with reassuring results are safely allowed to wait.
Who does the test
CION arranges endoscopy and banding through accredited partner hospitals and hepatologists. CION's oncologists then use the report when planning treatment such as immunotherapy or targeted therapy. Your team will tell you where the endoscopy takes place.
Who this does not apply to
If the liver is otherwise healthy and the cancer spread there from the bowel, breast or elsewhere, a varices check is not routine. Someone bleeding right now does not need this page. They need an emergency department.
Ask your team one direct question: "When is my next varices check due?" Write the answer down.Questions we are asked
Common questions about endoscopy for varices
Is the endoscopy painful?
Most people find it uncomfortable rather than painful. The throat is numbed and many people are given a sedative, so they remember little of it. Banding can leave the chest sore and swallowing uncomfortable for a few days. Tell the team if pain is severe or you cannot swallow liquids.
Can a scan replace the endoscopy?
Not fully. Scans and FibroScan readings help decide who can safely wait, but they cannot measure the veins or show the red marks that predict bleeding. When your doctor says an endoscopy is needed, a scan is not a substitute.
How often is it repeated?
It depends on what was found and how your liver is doing. People with no varices and stable liver function are checked less often. Those with small varices, worsening liver function or banding are checked more often. Your hepatologist sets the gap and should write it on your report.
Does it delay cancer treatment?
Usually only briefly, and the delay is planned. For medicines that raise bleeding risk, treating large varices first protects you. Your oncologist and hepatologist agree the order between them so the cancer plan is not put off longer than needed.
Can I eat normally after the test?
After a simple look, most people can eat once the throat numbness wears off. After banding, you are usually told to start with cool liquids and soft food for a short time. Follow the written instructions you are given, as they vary by hospital.
What if we have to travel from a district?
Ask whether the endoscopy can be timed with your other appointments in Hyderabad, so you travel once. Bring all old endoscopy reports. Do not drive yourself home after sedation, and plan for an adult to stay with you that day.
Is the test covered by schemes?
Aarogyasri, Ayushman Bharat and private insurance may cover endoscopy in some situations, but rules and packages change. Check with the scheme desk at the hospital before the test. The CION team can help with the paperwork.
Who should I ask about my own case?
Your hepatologist decides on the test itself. If you are not sure whether a varices check fits into your cancer plan, call the CION helpline. Someone will look at your reports and tell you honestly what is due and who to see.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- Cleveland Clinic — Esophageal Varices: Symptoms, Causes & Treatment
- MedlinePlus — Bleeding esophageal varices
- Merck Manual Consumer Version — Portal Hypertension
- NHS — Cirrhosis
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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Is a varices check due before your treatment?
Send us your latest reports and we will help you see whether an endoscopy is due and how it fits your cancer plan. One helpline serves every CION centre.