Oesophageal Stent. Patient Information

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1 Oesophageal Stent Patient Information

2 Introduction You have been advised to have a flexible metal tube inserted into your oesophagus (gullet). This is called an oesophageal stent. The stent will hopefully improve your swallowing and allow you to drink and/or eat better than you have been able to recently but you will need to make changes to your usual diet. This is an information sheet which describes the procedure and includes some useful tips about what to expect after stent insertion. It does not replace the discussion between you and your doctor but helps you to understand more about what is discussed. Why do I need a stent? You have been diagnosed with a cancer of the gullet and/or upper stomach. The cancer is causing a narrowing (stricture) or blockage to the gullet or upper stomach, preventing fluid and/or food from passing into your stomach. Inserting a stent (flexible metal tube) through the stricture may improve the swallowing and allow you to drink and eat. As with any procedure there are risks and you will be able to discuss these with the doctor carrying out the procedure. What is an oesophageal stent? An oesophageal stent is a flexible (bendy) tube placed in the gullet to keep a blocked area in the gullet open so the patient can swallow soft food and liquids. Oesophageal stents are made of a non dissolvable material and come in different sizes. They are held in place by the tumour and the muscles in the wall of the gullet. Narrowing in the oesophagus (stricture) due to cancer Once the stent has been inserted through the narrowed part of your gullet it will expand. As the stent expands it will open up the narrowing and be held in the correct position. Once the tube is fully expanded, food and drink should be able to pass through the tube and reach the stomach. 1

3 Stent in place What should I do to prepare before having my stent fitted? 1. Medication Please make a list of all medication that you are taking and bring this into hospital with you. If you have diabetes, which is controlled by insulin or tablets, tell the nurses at the hospital at least two days before you are due to come in. Phone: If you are taking Warfarin or Clopidogrel, you should contact the nurses at the hospital immediately for further advice. Phone: 2. Arranging your visit to hospital Please bring a dressing gown and slippers (if you have them) with you and an overnight bag, just in case you are asked to stay in hospital following the procedure. Please leave all jewellery and valuables at home as we cannot be responsible for them whilst you are here. You will need to make arrangements for an adult to collect you from hospital and stay with you overnight after you go home. Please let the endoscopy or theatre nurses know if you are not able to arrange this. Phone: 3. Eating and drinking You should not have anything to eat or drink for six hours before the procedure. How is the stent fitted? The procedure to fit a stent usually takes around half an hour. However, you should expect to be at the hospital for most of the day. 2

4 The procedure can be performed in one of three departments: endoscopy department, X-ray department or theatre. You will receive a sedative through a tube into one of your veins to make you sleepy. The stent is inserted by a specially trained doctor who will gently guide the stent into the narrowing in your oesophagus, using a gastroscope (a flexible lighted tube that lets the doctor look straight into your oesophagus and stomach). X- rays will be taken to make sure the stent is fitted in the right place. You may not remember anything about the procedure afterwards. Once the stent has fully opened, (up to two days after being fitted), the tumour and the muscles in the wall of the gullet should hold it in place. Are there any risks in having a stent fitted? Yes, there are possible risks with this procedure and the doctor fitting your stent will discuss these with you in more detail before you have this procedure. The risks include: perforation (making a hole in your oesophagus), bleeding and movement of the stent. The stent can slip into the stomach or become blocked by the tumour as it grows or large pieces of food. A stent which has slipped into the stomach does not generally cause any problems and usually does not need to be removed. If this happens, a new stent can be inserted. If there is only a small amount of tumour growing over the stent, this can be treated by: injection of the tumour with alcohol or burning the tumour to open up the way through again, or inserting a second stent into the first stent, depending on the location of your cancer. What if the narrowing in my gullet is at the bottom where it joins the stomach (gastro-oesophageal junction)? It is still sometimes possible to have a stent put in if the narrowing is at the bottom of the gullet. Your doctor may choose a different shaped stent for you. There is an increased risk of stent slippage into the stomach. Are there any alternative treatments instead of having the stent? If you are unsure about having the stent fitted, your doctor or clinical nurse specialist will discuss any other treatment options that may be possible for you. One of the alternatives, for some patients, involves injecting the tumour with alcohol and burning the tumour, but this may not be effective and 3

5 requires repeated endoscopies. X-Ray therapy (radiotherapy) or chemotherapy may sometimes be possible as an alternative. Why do I have to sign a consent form? The doctor needs your permission to put the stent in. You will be asked to sign a form to say you are willing to have the stent fitted. This will only be done after the doctor has explained why you need a stent and the risks involved. What happens following the procedure once your stent is fitted? You may get some pain/discomfort in your gullet after the procedure and for the next few days. This is because it takes up to 48 hours for the tube to expand fully. This is quite common so we recommend that you take painkillers that dissolve in water until this discomfort goes away. After you have had a stent inserted you will not be able to eat or drink for four hours afterwards. You will then be able to drink for the rest of the day. You must not eat until 24 hours after the stent insertion. Once the stent has expanded to its full size, it will stay fully open and will allow food to fall down without touching the sides of the oesophagus. You need to be aware that if you eat large lumps of hard, or poorly chewed food the stent does not push the food through like the oesophageal muscles would normally do and the stent may become blocked. You may also find that you suffer with heartburn following the stent insertion causing acid reflux from the stomach because the gullet is kept open by the stent. This can be controlled by anti-acid drugs and if you are not already on a special anti-acid tablet called Omeprazole or Lansoprazole, please discuss this with the endoscopy doctor on the day of the procedure. What symptoms should I look out for when I am at home? If in the three days following the procedure you experience any of the following symptoms, you should return to the Accident and Emergency department immediately: Difficulty breathing. Severe chest pain. Vomiting blood. Vomiting (where you are unable to keep food or drinks down). 4

6 If you are too unwell to make your own way to the hospital, call an ambulance. However, these problems are very rare. Please talk to the doctor if you want to discuss these further. Care of your stent There are some important facts you need to know about caring for your stent: Always eat sitting upright to aid digestion and try to remain sitting upright for at least half an hour after eating to prevent regurgitation. It is important to eat slowly. Chew your food well and if you wear dentures, ensure they fit properly. We would recommend that you begin with pureed food and gradually build up to more solid food. Frequent drinks help to keep your stent clear by loosening any food products that may have stuck against the walls. Do not try to eat big lumps of food or chunks of meat. Spit out anything you have been unable to chew properly. Foods that may cause problems There are certain foods that are more likely to block the stent. These are foods such as: Green salads and raw vegetables. Fried egg white and hard boiled eggs. Fruit skin and the pith of grapefruit or orange, pineapple. Tough meat and gristle. Fish with bones. White bread and toasts Shredded and puffed wheat. Chips. Stringy vegetables. Pineapple. Please avoid these foods. Hints and tips It is important to eat a balanced diet when possible. If your appetite is poor, a drop of sherry before meals may help 5

7 Don t stick rigidly to mealtimes; eat when you are hungry. Eat small amounts and often. If you feel too tired to eat, let others cook for you or you could have meals on wheels for a while. Convenience foods may be useful or prepare food when you are feeling well and freeze it for when you are tired. You may find it easier to eat after a nap. Don t eat within an hour of bedtime. Prop yourself up in bed with extra pillows at night to reduce acid reflux. If you are concerned about your weight loss; contact your Clinical Nurse Specialist for advice and support, she will refer you to a dietician who will advise you on appropriate diet. If you find you cannot swallow either food or fluids the stent may be blocked. Try a fizzy or warm drink and walk about. If this does not work or you are not able to swallow after a couple of hours then contact the Endoscopy Department or your Clinical Nurse Specialist. If the department is closed, contact your GP who will be able to advise you. If you have any questions about your stent please contact your Clinical Nurse Specialist. Local sources of further information You can visit any of the health/cancer information centres listed below: Heart of England NHS Foundation Trust Health Information Centre Birmingham Heartlands Hospital Bordesley Green Birmingham B9 5SS Telephone: Cancer Information and Support Centre Good Hope Hospital Rectory Road Sutton Coldfield B75 7RR Telephone:

8 Sandwell and West Birmingham Hospitals NHS Trust The Courtyard Centre Sandwell General Hospital (Main Reception) Lyndon West Bromwich B71 4HJ Telephone: Fax: University Hospital Birmingham NHS Foundation Trust The Patrick Room Cancer Centre Queen Elizabeth Hospital Edgbaston Birmingham B15 2TH Telephone: Walsall Primary Care Trust Cancer Information & Support Services Challenge Building Hatherton Street Walsall WS1 1YB Freephone: About this information This guide is provided for general information only and is not a substitute for professional medical advice. Every effort is taken to ensure that this information is accurate and consistent with current knowledge and practice at the time of publication. We are constantly striving to improve the quality of our information. If you have a suggestion about how this information can be improved, please contact us via our website: This information was produced by Pan Birmingham Cancer Network and was written by Consultant Surgeons, Clinical Nurse Specialists, Allied Health Professionals, Patients and Carers from the following Trusts: Heart of England NHS Foundation Trust Sandwell and West Birmingham NHS Trust University Hospital Birmingham Foundation Trust Walsall Hospital NHS Trust 7

9 We acknowledge the support of Macmillan in producing this information. Pan Birmingham Cancer Network 2010 Publication Date: June 2010 Review Date: June

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