Information for Patients having a Colonic Stent Placement

Information for Patients having a Colonic Stent Placement

Information for Patients having a Colonic Stent Placement The Digestive System To understand the procedure you are about to have, it helps to have some knowledge of how your body works. When food is eaten it passes from the mouth down the oesophagus (food pipe) into the stomach. Here it is broken down and becomes semi-liquid. It then continues through the small intestine (small bowel), a coiled tube many feet long, where nutrients are digested and absorbed. The semi-liquid food is then passed into the colon (large bowel), a wider, shorter tube, where it becomes faeces (waste). The main job of the colon is to absorb water into our bodies so making the faeces more solid. The faeces then enter the rectum (storage area). When the rectum is full, we get the desire to open our bowels. The waste is finally passed through the anus (back passage) when going to the toilet. What is a stent? A stent is a hollow tube made of a flexible alloy mesh. Stents can be rolled up tightly to the size of a pencil to allow them to be inserted through the blockage or tumour in the bowel. Once in place, stents are allowed to expand and therefore keep open the passage through the tumour. Why are stents used? Stents can be used for the following reasons: Stents are suitable for patients who have complete or partial bowel obstruction (blockage). The aim of a stent in these patients is to relieve the obstruction, especially if the patient is not considered suitable for surgery In patients who have potentially curative cancers, where the bowel is obstructed, a stent is used prior to surgery. Placing a stent allows the bowel to empty and return to its normal size and this can make eventual surgery safer. Review date: February 2011 1

What are the benefits of having a Stent Placement? Stenting is a minimally invasive procedure which relieves the pressure within the bowel allowing free passage of faeces Stenting can be used as an alternative to surgery in patients who are medically unfit or have metastases (spread of disease). These patients can avoid major surgery and the need of a stoma. Are there any risks? Perforation The procedure may cause perforation (a hole) leading to leakage from the bowel into the abdomen. If this happens, you may require further treatment including an operation. Perforation is rare (less than 5%) but it can be serious and life threatening. Malpositioning Positioning the stent may be difficult due to the growth and position of your tumour. If positioning is unsuccessful then the procedure will be abandoned. If this happens, the procedure may be repeated at a later date or your Consultant will discuss an alternative plan with you. Migration Loosening of the stent could cause it to move. Treatment may include removal of the stent, replacement, surgery or simple observation. Symptoms of migration may include: Pain and urgency in the back passage Recurrence of your previous symptoms of obstruction These symptoms should be reported promptly to your Consultant or Specialist Nurse. Bleeding A small amount of bleeding may occur. This may come from the tumour or the stent rubbing against the tumour Pain Some abdominal pain may be experienced as the bowel returns to normal function The majority of patients who experience discomfort (in the back passage) are patients with stents in the rectum. This is usually tolerated, after an initial period of discomfort If your pain is severe this may indicate obstruction, perforation or migration. If this is the case, you should seek medical advice Review date: February 2011 2

Re-obstruction This can be caused by over growth of the tumour through the stent, blocking the bowel. If this occurs, you may experience symptoms of obstruction Your bowels may stop working Your abdomen may become bloated You might start vomiting or have abdominal discomfort If this happens you should seek medical advice. This may require insertion of another stent. Most people will not experience any serous complications from this intervention. Your Consultant will discuss these risks with you. What are the alternatives to having a stent? Doing nothing will very likely lead to complete blockage of the bowel Major surgery may be an option but has increased risks involved If you are taking medication Patients taking regular analgesia (in particular morphine) will receive information on long-term laxative use. If you are taking medication If you are diabetic Do not take your diabetic medication on the morning of your admission. Bring this with you so you can take it once the procedure is completed. You can continue to drink sugary fluids prior to your procedure to help maintain your blood sugar levels. As you cannot eat food, have sugary drinks (not low calorie drinks) such as Lucozade, lemonade or fruit squash. These should help to maintain normal blood sugar levels. If you take Warfarin (medication to thin your blood ) - You may need to stop this for a number of days prior to your admission. You would usually have been given instruction regarding this by your Consultant but, if you have not, please contact us (as below) for further advice. If you take Clopidogrel - You may need to stop this for a number of days prior to your admission. You would usually have been given instruction regarding this by your Consultant but, if you have not, please contact us (as below) for further advice. If you are taking any medication containing iron, such as ferrous sulphate or multi vitamins containing iron, please stop these seven days before your admission. Please ensure you take any medication for heart or blood pressure throughout your preparation, as well as any other regular medication. If you have any questions regarding preparation, please contact the Endoscopy Unit where you will be attending for your procedure where a nurse will be pleased to advise you. What will happen when I arrive at the hospital? The procedure is usually performed in the X-ray or Endoscopy Department Review date: February 2011 3

You will be asked to sign a consent form You will be asked to change into a gown please bring a dressing gown and slippers with you You will be given an enema immediately prior to the procedure to empty your lower bowel You will be asked to lie on your left side or back on a treatment trolley You will be offered a sedative and analgesia before and during the procedure A cannula (a small plastic tube inserted with a needle) will be placed into your hand, to administer sedation. The sedative will relax you or may make you drowsy during the procedure. The procedure will take approximately 60-90 minutes to complete, depending on your individual circumstances Sometimes it may take more than one attempt to position the stent. Occasionally it is not possible to do the procedure, in which case, your Consultant will discuss an alternative plan with you After the procedure You may require an x-ray to assess the position of the stent and to rule out perforation. You will be able to go home once the doctors are happy that the stent is in the correct position and that the bowel is working again. You may experience some bleeding from your bowel in the first two days after insertion but this should stop. The bowel may feel uncomfortable, possibly painful for up to three days. Please ask for painkillers if you need them. If you continue to experience pain or bleeding persists, please contact your Hospital Consultant or Colorectal Clinical Nurse Specialist. Results The stent will reach its maximum diameter within 24 hours. It will only stretch as far as the narrowing allows, up to maximum of 3 cm. Your bowel function will therefore be dependent upon the degree of expansion achieved. It generally helps to eat a low fibre diet; as a guide this means eating foods that do not need a lot of chewing. Please ask for a low fibre diet sheet. A daily dose of softening laxative may be recommended to help the bowel motions remain loose and easy to pass. It is important to continue to drink plenty of fluids. Discharge Advice It is important to monitor your bowel function and report any new episodes of pain and/or bleeding to your Consultant or Colorectal Nurse immediately. It is important to continue to take an adequate fluid intake and taking laxatives as prescribed. You must inform any doctor who may need to perform a rectal examination that you have a stent in place. Review date: February 2011 4

Glossary of medical terms used in this information Analgesia A painkiller Metastases Obstruction Perforation Rectum Stent Stoma A new tumour that has spread from the original site, also known as a secondary A blockage in the bowel A hole in the bowel The outermost portion of the large intestine. Faeces are stored in the rectum until they are passed out of the body through the anus A hollow tube made of a flexible alloy mesh used to keep open the passage through the tumour An opening made into the bowel via the skin on the surface of the abdomen (belly) Any further questions? If you have any questions/problems before or after your treatment you can contact us as on the telephone numbers below. Please have your Medical Record Number (MRN) available. Location Colorectal Clinical Nurse Specialist Telephone Chase Farm Hospital Kim Jaggs 0845 111 4000 bleep 3660 Location Colorectal Clinical Nurse Specialist Telephone Barnet Hospital Angela Wheeler 0845 111 4000 bleep 2636 Outside of these hours in an emergency please contact NHS Direct on 0845 4647 or your local Accident and Emergency Department This information was compiled using some information and illustrations from the Pan Birmingham Cancer Network in conjunction with Cancer Backup Review date: February 2011 5

Review date: February 2011 6