Radiology - Oesophageal Stent Insertion

What is an oesophageal stent insertion?

The oesophagus (gullet) is a tube which takes food from the mouth down to the stomach. If it becomes blocked, then there will be a problem with swallowing. One way to overcome this problem is to insert a mesh tube (stent) down the oesophagus and across the blockage. This should make swallowing easier as the food can then pass down the oesophagus through the stent.

Why do I need an oesophageal stent insertion and who has made this decision?

The symptoms you are having and other tests that you may have had done suggest that the oesophagus has become blocked. The consultant in charge of your care feels that this is the best way of treating this problem. We usually plan a stent in advance, so you have time to discuss your options with your consultant or their team. Your opinion will be taken into account. If you do not want this procedure, you can decide not to have it at any time, even after signing the consent form.

Are there any alternatives to this procedure?

Other procedures can be done which allow you to have liquid feed directly into your stomach, but they will not improve your ability to eat or drink. These methods may not be suitable for you so you should discuss them with your consultant.

What are the risks and complications?

Oesophageal stent insertion is a safe procedure and serious complications are rare. Despite these risks, your consultant has decided to refer you for a stent insertion. This is because they feel that the benefits of having this procedure outweigh the risks. Your consultant or one of their team will discuss your options with you in advance. The risks include the following:

• Bleeding – Significant bleeding is very rare
• Pain – It is not unusual to feel moderate chest pain while the stent “beds in”, but this can usually be controlled with painkillers and normally settles in a day or two. Severe pain is rare. Some patients get heartburn afterwards and need to take medicine for this
• Stent slippage – This is the most common complication. Stents slip in approximately 1 in 10 cases (10%). If the stent blocks or slips, you may require another procedure to place a new stent or to retrieve the slipped stent
• Stent blockage – This occasionally occurs and may require an endoscopy procedure to treat. This can be prevented by carefully chewing food and drinking a reasonable quantity of fluids during meals
• Oesophageal tear and perforation – Very rarely the procedure may cause a tear in the oesophagus. This is a serious condition and may need an operation.

Despite these possible complications, the procedure is normally safe, and should result in a great improvement in your quality of life. If you have any worries, please do not hesitate to discuss possible complications or risks with hospital staff before your procedure.

How do I prepare for an oesophageal stent insertion?

If you are not already an inpatient, you will be admitted to the hospital on the day of your procedure. You will have some blood tests performed beforehand to check that you do not have an increased risk of bleeding. You should not eat or drink for six hours before your procedure. If you are taking any medication that thins your blood, please inform the hospital consultant/ department with the details below at least one week before your procedure. Your blood thinning medication will need to be stopped in advance. If you are diabetic, please discuss medicines with your hospital doctor or the diabetes nurses. You can continue to take any other medicines. If you have any allergies, you must let one of the team know when you attend.

What happens during an oesophageal stent insertion?

A specially trained doctor called a radiologist will be doing your procedure in the radiology (x-ray) department. Using x-rays will allow the doctor to place the stent at the site of the blockage. The procedure length varies for everyone but generally it takes about 30 minutes. The radiologist will speak to you beforehand and answer your questions. Please let them know if you are allergic to anything. You will have a small needle (cannula) placed in your arm. You will need to remove any false teeth, glasses or contact lenses. The back of your throat will be sprayed with an anaesthetic to numb it and you will be asked to lie on the x-ray table, usually on your side. You will be given some medication (sedative) to make you feel sleepy and some painkillers. Your pulse and blood pressure will be monitored throughout the procedure. The stent is passed through your mouth over a wire into the correct position in your oesophagus. You may gag slightly during the procedure; this is quite normal and ill not interfere with your breathing.

What happens afterwards?

You will be taken back to your ward or to recovery on a trolley. The nurses will carry out routine observations, such as taking pulse and blood pressure, to make sure that there are no problems. You will generally stay in bed for a few hours, until you have recovered. You will need a chest x-ray around 4 hours after placing the stent to check the stent position this will be organised by the ward staff. You will need to stay in hospital overnight.

How soon can I eat and drink?

You will be kept nil by mouth until after you have had a chest x- ray and this has been looked at by the doctor, this is to ensure the stent is in the correct position and has opened fully. After this time, you should be able to start on fluids. Then you should have a fairly liquid diet for a few days, before introducing soft solids.  Solid food should be well chewed before swallowing. You will be seen by a dietitian before you go home for further advice.

What symptoms should I look out for when I am at home?

If in the first few 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).

If you are too unwell to make your own way to hospital, call an ambulance. However, these problems are very rare. Please tale to the doctor if you want to discuss further.

Could you be pregnant?

If there is any chance you could be pregnant, please call 0161 206 5091 if your appointment is at Salford Royal Hospital. Please call 0161 656 1178 if your appointment is at Royal Oldham Hospital.

Is x-ray guidance dangerous?

All x-ray machines use potentially harmful x-rays. Modern equipment is designed to keep the dose you receive as low as possible. If your doctor has asked for this test, they will have decided that the benefits from the procedure outweigh the risks from the very small dose of radiation that you receive.

What if I cannot attend my appointment?

If you have any queries about your appointment or cannot attend, then please telephone the booking office on:
0161 204 2044/2404 (Salford Royal Hospital)
0161 624 0420 (Royal Oldham Hospital)
Monday to Friday 8.30am to 4.00pm.

You can also email:
salford.radiology.booking@nca.nhs.uk (Salford Royal Hospital)
bookingandscheduling.outpatients@nca.nhs.uk (Royal Oldham Hospital)
Please include name, date of birth, address and hospital number (if known) in any correspondence.

I need an ambulance. How do I arrange one?

If you need an ambulance there are contact details on your appointment letter.

Please contact us if you are arriving by ambulance so we can time your appointment with your ambulance arrival. If we are not aware that you are coming by ambulance you may miss your appointment and it may have to be rebooked.

If you need an interpreter

If you need an interpreter for your examination, please call the department so that we can try and arrange this.

Contact Details

We hope your questions have been answered by this leaflet.

If you require help or any other information regarding your appointment you can contact:

The Angiography Department, Salford Royal Hospital
Tel: 0161 206 2206/5091

Interventional Radiology, Royal Oldham Hospital
Tel: 0161 656 1178