66 Having an Oesophageal Stent Insertion Introduction This leaflet tells you about the procedure known as oesophageal stent insertion. This is likely to be performed as a pre- planned procedure. What is an oesophageal stent insertion? The oesophagus (or gullet) is a hollow muscular tube which takes food from the mouth down to the stomach. If it becomes blocked there will obviously be a problem swallowing. One way of overcoming this problem is by inserting a metal mesh tube, called a stent, down the oesophagus and across the blockage. Food can then pass down the gullet through the stent and this should make swallowing easier. Why do I need an oesophageal stent inserted? Other tests that you might have had, such as endoscopy or barium swallow, will have shown that your oesophagus has become blocked. Your doctor will have discussed with you the likeliest cause of the blockage and the possible treatments. Having a stent does not prevent you undergoing an operation. Who has made the decision? Your consultant and the radiologist doing the oesophageal stent insertion will have discussed your situation and feel that this is the best treatment. You will have the opportunity for your opinion to be considered, and if after discussion with your doctors you do not want the procedure carried out, you can decide against it. Where will the procedure take place? Generally in the X-ray Department in a special “screening” room, this is adapted for specialised procedures. Some stents may be inserted in the Endoscopy department. Who will be doing the oesphageal stent insertion? A specially trained doctor called a radiologist. Radiologists have a special expertise in using x-ray equipment and also in interpreting the images produced. They need to look at these images while carrying out the procedure to make sure the stent is positioned correctly. How do I prepare for oesphageal stent insertion? You will be an in-patient. You will be asked not to eat for four hours beforehand, though you will be allowed to drink some water. You will be asked to put on a hospital gown, before transfer to the X-ray department on a trolley. You must tell the doctor about any allergies, especially any previous reactions to intravenous contrast medium, the dye used for x-rays and CT scanning. 66 What actually happens during an oesophageal stent insertion? You will lie on the x-ray table, either flat on your back or on your right side. You will have a cuff wrapped around your upper arm to measure your blood pressure also you may have a monitoring device attached to your finger and oxygen given through small tubes. The radiologist will spray the back of your throat with local anesthetic to make the procedure more manageable for you. To start with a fine tube, called a catheter, is passed through your mouth down the gullet and through the blockage. A guide wire is passed down the catheter, which can then be removed, leaving the guide wire in place. The stent is then passed over this wire and into the correct position across the blockage, where it expands to open the channel. Once the radiologist is satisfied the x-rays show the stent in the correct place, the guide wire is withdrawn leaving the stent in position. Will it hurt? Unfortunately, it may hurt a little, for a very short period of time, but any pain you have can be controlled with painkillers as necessary. There will be a nurse, or another member of the clinical staff, looking after you. If the procedure does become uncomfortable for you then they will be able to arrange for you to have some painkillers. How long will it take? Every patient’s situation is different, and it is not always easy to predict how complex or straightforward the procedure will be. It may be over in half an hour, but occasionally it may take an hour. As a guide, expect to be in the department for about an hour and a half altogether. What happens afterwards? You will be taken back to the ward on a trolley, and will need to rest in bed for a few hours until you have recovered. Routine observations, such as taking your pulse and blood pressure will be carried out to make sure there are no problems. Most patients will be able to start on fluids within a few hours. A barium swallow may be performed the next day, to check the position of the stent and to see how well it is working. If the stent has opened out fully then you can start on a varied diet. When more solid food is allowed it should be cut small and chewed properly before swallowing. Although the channel provide by the stent is about the same size as the oesophagus, it does not have the normal muscular activity, therefore large pieces of food can become stuck. If food does appear to be lodged at any time then “fizzy” drinks are often helpful to clear it. Are there any risks or complications? Oesophageal stent insertion is a very safe procedure bit as with any medical treatment, there are a few risks and complicationsIt is not unusual to feel mild to moderate pain while the stent “beds in” but this normally settles in a day or two. Some patients get heartburn afterwards and need to take medicine for this. Some patients find sleeping propped up with extra pillows helps. It is possible that a little bleeding occurs during the procedure but this generally stops without the need for action. Very rarely, the stent may slip out of position and it is necessary to repeat the procedure. Very, very rarely, putting in a stent may cause a tear in the oesophagus. This is a serious condition and may need an operation or another stent. When stents have been in position for some time, the original problem may extend, so the stent no longer covers the full length of the narrowing. If this occurs, it is possible to place a second stent to re-open the channel. Despite the possible compilations, the procedure is normally very safe and is carried out with no significant side effects at all. If you have any further questions please contact the X-ray department on: 01246 512627 66 Having an Oesophageal stent inserted Version 1 © Chesterfield Royal Hospital NHS Foundation Trust Reviewed Date: February 2017 Next Planned Reviewed Date: February 2018 Directorate: Endoscopy
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