Having an oesophageal stent insertion

Transcription

1 Having an oesophageal stent insertion Information for patients, relatives and carers 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 this tube becomes blocked, you will have problems with swallowing. One way of overcoming this is by inserting a metal, mesh tube (called a stent) down the oesophagus and across the blockage. Food can then pass down the oesophagus through this stent and this should make swallowing easier. This procedure is called oesophageal stent insertion. The majority of oesophageal stents stay in, but sometimes they may be temporary. The stent is inserted under local anaesthetic and sedation (you will be awake and feel very relaxed but should feel no pain). The local anaesthetic is usually a spray in the throat immediately before the procedure. Sedation and pain relief are used during the examination as required. A specially trained doctor, the interventional radiologist, will use X-ray guidance to ensure that the stent is placed accurately and the time taken to insert it is kept to a minimum. Why do I need oesophageal stent insertion? The doctors in charge of your case have recommended that you have this procedure because other tests that you might have had done (either an endoscopy or barium swallow) have shown that your oesophagus has become blocked. Your doctors will already have discussed with you the likeliest cause of the blockage and the possible treatments. Your doctors will only have requested oesophageal stent insertion if they feel that this is the best way to treat your condition. It is likely that an operation has been ruled out and that a stent insertion is considered the best treatment option for you. However, if after discussion with your doctors you decide you do not wish to have a stent insertion, we will respect your choice. Please note that it will not affect your treatment in any way. What are the risks and benefits? The benefit of this procedure is that it is very safe and quick, and can often remove blockages without the need for surgery. p1

2 After stent insertion, the majority of people have an improvement to their swallowing. As with any medical treatment, there are some risks and complications that can arise: Slight bleeding during the procedure, but this generally stops on its own. Mild to moderate chest pain while the stent beds in, although this normally settles within a day or two of the procedure. Some patients get heartburn afterwards and need to take medicine for this. Rarely the stent may slip out of position. If this happens, we may have to repeat the procedure. Extremely rarely, inserting the stent may cause a tear in the oesophagus. This is a serious condition and may need an operation or the insertion of another stent. The chances of complications depend on where the blockage is in the oesophagus. Blockages nearer the mouth are more likely to cause complications than blockages near the stomach. X-ray guidance assists with correct placement of the stent and minimises the risk of complications. Who will be performing my treatment? A specially trained doctor called an interventional radiologist will insert your stent. Interventional radiologists have special expertise in using X-ray equipment and interpreting the images produced. They need to look at these images while carrying out the procedure to make sure that the stent is positioned correctly. How do I prepare for oesophageal stent insertion? You will be admitted to hospital on the same day or the day before your procedure. In exceptional circumstances, this procedure may be carried out as a day case, but this will be discussed by your doctors and the consultant interventional radiologist before the procedure. Steps to prepare for your procedure: We will ask you not to eat anything for four hours before your appointment time, although you may be allowed to drink water. Please let us know if you have asthma or are allergic to any medications. You can take all your medications as usual, except blood-thinning tablets, such as warfarin. If you do take them, you must tell your doctor, as you may be advised to stop taking them for some time before you have your appointment. If you are pregnant, or think you might be pregnant, you must tell the imaging staff so that appropriate advice can be given. p2

3 What happens during an oesophageal stent insertion? We will discuss the procedure with you in detail and ask you to sign a consent form. This is to make sure that you understand the risks and benefits of having the test. You will be asked to change into a hospital gown. Staff in the imaging department will then check your details and examine you before taking you to a special screening room in the interventional radiology suite, where the procedure will take place. The exact technique may vary slightly but a general outline of the procedure is as follows: The interventional radiologist, nurse or radiographer will put a small needle, containing sedative or painkillers, into a vein in your arm or back of your hand to relax you. Once in place, this needle does not cause any pain. You will be taken into the screening room and asked to lie on the X-ray table. You will also have a monitoring device attached to your chest to check your heart, an instrument on your finger to check your oxygen levels and an inflatable cuff on your arm to monitor your blood pressure. You may receive oxygen through small tubes in your nose and a flexible, long tube (suction catheter) may be used to remove anything that you may cough up during the procedure. The interventional radiologist will usually spray the back of your throat with local anaesthetic to make the procedure more manageable for you. When the area is completely numb, the radiologist will pass a fine tube through your mouth, down the oesophagus and through the blockage. The stent is then passed over this fine tube and into the correct position across the blockage. Once the stent is in place, the fine tube is removed. Sedation to relax you is usually given just before starting and during the procedure. Pain relief is given during the procedure. Will it hurt? Unfortunately, it may hurt a little, for a very short period of time. However, any pain you have should be controlled with painkillers. You may feel some discomfort in your throat during and after, but this should not be too sore. There will be a nurse, or another member of clinical staff, looking after you throughout the procedure. If you have any discomfort or pain, please tell her/him and you will be given more painkillers. p3

4 How long will it take? Every patient's situation is different and it is not always easy to predict how complex or how straightforward the procedure will be. Placing the stent in the oesophagus does not take very long. The whole procedure usually takes about 45 minutes, but occasionally it may take an hour. As a guide, expect to be in the X-ray department for about an hour and a half in total. What happens afterwards and when can I go home? We will take you back to the radiology day ward. The nursing staff will carry out routine observations, such as taking your pulse and blood pressure, to make sure all is fine. You will need to rest in bed for about four hours until you have recovered from the sedation. For the rest of the day you must not: Drive or operate machinery (including kitchen equipment) Drink alcohol Sign any important or legal documents You must have a friend or relative (18 years of age or older) to take you home and care for you overnight. You should be able to return to work and all your usual activities the day after your appointment. You will be required to return to the hospital the day after your stent insertion for an X-ray swallow test, and you will be given the appropriate instruction for this before you leave. If you have been admitted to the ward, it is up to the clinical team in charge of your care to decide when you can go home. It is usually after you have had an X-ray swallow test the day after your oesophageal stent insertion. When can I start eating and drinking normally again? Most patients will be able to start on fluids within a few hours. It is necessary to have a fairly liquid diet for a few days, until you can start to have soft food. Please make sure that you chew any solid food thoroughly before swallowing. You may be able to go back to a normal diet after an X-ray swallow test on the following day. Your referring team will be able to give you information about your diet. Is there anything I need to watch out for at home? If you have increased difficulty in swallowing and breathing, or pain in your chest and/or abdomen, please contact your GP for advice or go to your nearest A&E. p4

5 What if I cannot keep my appointment? Please contact us as soon as possible. We can then offer this date to another patient and agree a new appointment date and time with you. You will find the appropriate telephone number on your appointment letter. Useful contact numbers Imaging department, St Mary s Hospital How do I get to the hospital? You are advised to travel, if possible, by public transport when visiting our hospitals. Car parking is severely limited and you may find it very difficult to find a place to park nearby. The nearest tube stations to St Mary s Hospital are Paddington (Bakerloo, Circle, District, and Hammersmith and City lines) and Edgware Road (Bakerloo, Circle and District lines). Buses that stop on Praed Street are numbers 7, 15, 23, 27, 36 and 436. How do I make a comment about my treatment? We aim to provide the best possible service and staff will be happy to answer any questions you may have. However, if your experience of our services does not meet your expectations and you would like to speak to someone other than staff caring for you, please contact the patient advice and liaison service (PALS) on (St Mary s Hospital). You can also PALS at pals@imperial.nhs.uk. The PALS team will listen to your concerns, suggestions or queries and is often able to help sort out problems on behalf of patients. Alternatively, you may wish to express your concerns in writing to: The Chief Executive Imperial College Healthcare NHS Trust Trust Headquarters The Bays, South Wharf Road London, W2 1NY Alternative formats This information can be provided on request in large print, as a sound recording, in Braille, or in alternative languages. Please contact the communications team on Imaging department Published: December 2008; July 2010; January 2012 Review date: January 2015 Reference no: T1097/VER3 (previously known as CIS/022/2008/VER2) Imperial College Healthcare NHS Trust p5