Oesophageal Stenting. South Tyneside. Patient information booklet. Providing a range of NHS services in Gateshead, South Tyneside and Sunderland.

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1 South Tyneside NHS Foundation Trust Oesophageal Stenting Patient information booklet Providing a range of NHS services in Gateshead, South Tyneside and Sunderland.

2 This leaflet gives you information about the procedure on having a stent (a pipe which helps you to swallow easier) inserted into your oesophagus to help with your symptoms. This leaflet is in addition to the on-going discussions that you will have with the consultants and nurses involved in your care. It is important that you understand the procedure before you sign the consent form. What is an oesophagus? The oesophagus (gullet) is a hollow muscular tube that carries food and liquids from the mouth to the stomach. It is part of the digestive system. What is insertion of an oesophageal stent? Part of your gullet (oesophagus) has become blocked or narrowed and due to this you are having difficulty in swallowing. One way of overcoming this problem is by inserting a metal mesh tube, called a stent which is passed through the mouth into the oesophagus and through the blocked area. The procedure to place the stent is called oesophageal stent insertion (see diagram below). The stent gently expands to allow the food to pass through the stent into the stomach. This will make swallowing easier. Oesophagus Stent Stomach A diagram of the stent in the oesophagus 2

3 Why do I need an oesophageal stent insertion? The results of the endoscopy (telescope test) or barium swallow examination that you have had done, have shown that there is a blockage or narrowing of your oesophagus. Other alternatives to improve the swallowing such as an operation or laser treatment may also have been considered but a stent insertion has been proposed as the best treatment option for you at this time. However, if after discussions with your doctor you do not want the procedure carried out, then you can decide against it. Who will be doing the procedure and where? A gastroenterology consultant with special expertise in this procedure will ensure that the stent is positioned correctly. A gastroenterology registrar under the supervision of the consultant may also place the stent. Sometimes two specialists are required; a Gastroenterologist who will insert the stent and a Radiologist who specialises in interpreting the x-ray images. Both specialists need to look at these images while carrying out the process, to make sure that the stent is positioned correctly. The procedure is usually performed in the x-ray department. What is the preparation for the procedure? If you are not already an in-patient arrangements will be made for you to attend hospital on the morning of the procedure. Your stomach needs to be empty, so you will be asked not to eat or drink for at least six hours before the procedure. Individual instructions will be sent to you before the procedure. If there are any special arrangements you need such as an interpreter or sign guide please advise the bookings team at least 72 hours before your appointment. You should continue all your oral medications but if you take any medications that make your blood thinner other than aspirin (anticoagulants) such as warfarin, phenindoine, acenocoumarol, clopidogrel, prasugrel, diyridamole, ticagrelor, dabigatran, 3

4 rivaroxaban and apixaban, you should inform your Consultant and the bookings team immediately on If you are diabetic on injectable or oral medication please contact the diabetes specialist nurse for dietary and medication advise on at least 48 hours before your appointment. Diet controlled diabetics do not need to contact the specialist nurse. If you have a family history of CJD please contact the unit on If you are allergic/sensitive to rubber or latex please contact the unit immediately on Failure to contact us regarding any of the above may result in cancellation of your appointment. What happens during the procedure? You will be asked to lie on your back or on your left side. You will have a small needle put into a vein in your arm, so that the doctor can give you a sedative to relieve anxiety and painkillers intravenously just before the procedure starts to make sure that you are kept comfortable throughout your test. We will attach a probe to your finger to allow us to measure your pulse and the amount of oxygen in your blood. You will also receive oxygen through small nasal prongs. The doctor may also spray the back of your throat with local anaesthetic to numb your throat. An endoscopy will be performed to enable the stent to be inserted. The stent will gently expand enough to allow food and fluids to pass into the stomach. The procedure usually lasts 20 to 30 minutes. After you have recovered from sedation you will be taken back to the day ward. Your pulse and blood pressure will be monitored for a few hours to make sure that there are no problems. Most patients are able to return home the same day. 4

5 Will it hurt? You may experience some chest or back pain until the stent fully expands. In the majority of cases the discomfort settles within a day or two. It is important that you let your nurse or doctor know immediately if you do have any pain or discomfort so that it can be controlled with painkillers. What are the risks and benefits? Oesophageal stent insertion is generally a very safe procedure, but as with any medical treatments there are some risks as follows: Occasionally a little bleeding can occur during the procedure. This generally stops without further treatment Some people get heartburn and acid reflux afterwards. This can be controlled with medication Rarely the stent may slip out of position. If this happens it will be necessary to insert another stent. Very rarely, the placement of a stent may cause a tear in the oesophagus particularly if the gullet needs stretching beforehand. This is a serious condition, and may need an operation to repair the tear, or insertion of another stent. Despite these complications the risks are small, the procedure is generally safe and will result in a great improvement in your ability to eat. After a few days you should not be aware of the stent being there. How soon after the procedure can I eat and drink? Most patients will be able to drink fluids within a few hours. You will need to have a liquid diet for a few days, before starting on soft solids. You can then gradually begin to eat more. Solid food should be chewed properly before swallowing. Big chunks of meat or other solid food should be avoided as they can block the stent. 5

6 Try to have small but frequent meals. It is important to drink plenty of fluids before and after each meal. This helps the stent to remain open. You should try to eat in an upright position. Most patients are back on a fairly normal diet within a week. You will also be given a strong antacid medication to prevent you from developing acid reflux and heartburn. At home, if you have difficulty in swallowing this is a sign that the stent may have blocked. In this case do not panic! Stop eating. Take some fizzy drinks, and walk around, this may unblock the stent. If the blockage persists contact your GP or your nurse specialist in the hospital immediately to have the stent unblocked. To unblock the stent an endoscopy will be carried out. What kind of food can I eat? It is advisable to begin by eating liquidised meals. When you feel comfortable with liquidised meals you can gradually progress to soft, moist foods. There are some foods that may cause difficulty in swallowing, and you should try to avoid them as they can block your stent. The kinds of food that we recommend you to eat and what to avoid are listed below:- Foods to AVOID Fish with bones Tough fibrous meats Cubes of hard cheese Fresh/doughy crispy bread and toast Suitable alternatives Flaked or mashed fish with no bones Tender meat, that is minced, finely chopped or liquidized. Grated cheese or in a sauce. Cottage or curd cheese Crackers, crispbreads, day old bread dipped in liquid such as soup 6

7 Foods to AVOID Cereals of a fibrous consistency such as Muesli and those containing nuts and dried fruit Hard foods such as nuts, crisps, crackers, hard chips Hard boiled eggs Fried egg white Fruit with pith, pips and stringy texture e.g. rhubarb, orange, grapefruit, strawberries, raspberries, kiwis Avoid yoghurts and desserts containing large chunks of fruit Vegetables with pips and stringy textures e.g. celery, green beans, sweetcorn, peas, broccoli and cauliflower stalks. Suitable alternatives Porridge type cereals Well mashed hard boiled eggs, Scrambled, poached, omelette, egg mayonnaise Small pieces of raw apples, pears, peaches, bananas and melon with peel and pips removed and chewed well. Any desserts of soft, fairly uniform consistency, e.g. milk puddings, yoghurt without fruit, egg custard Well cooked or mashed vegetables particularly those that avoid pips and stringy textures eg carrot, broccoli and cauliflower tips, courgette (peeled). Mushy peas It can be very helpful to talk to a dietician before, or soon after, your stent insertion. They can advise you in making changes to your diet. The Senior Dietician or one of her colleagues will be happy to talk to you. While you are in the hospital the staff on the ward, your consultant or your nurse specialist can arrange for you to meet the dietician. At home, your GP may also be able to refer you to a communitybased dietician. 7

8 Looking after your stent Eat in an upright position. Take small mouthfuls of food. Eat slowly and chew your food well. Use plenty of sauces, gravy and butter to moisten food. If your appetite is poor, try to have small and frequent nourishing meals Try to have warm drinks whilst eating to prevent the tube from blocking Drink plenty of fizzy drinks (sparkling water, cola etc) before and after each meal; this will help the stent remain open Can the stent come out? Once the stent is in place it will usually be permanent. For more information contact? Endoscopy Day Unit South Tyneside District Hospital Tel: extension 2247 or extension 2252 We are committed to raising the standard of written information for patients, their carers, people who use the NHS and the general public. This information can be made available in another format or language on request. For further copies of this leaflet please contact on telephone numbers above. Production date: October 2016 Author: Nurse Lead Endoscopy Code: 1016/438 Review date: October 2019

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