Gastroscopy with Oesophageal Stent Inserted

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Oesophagus = Gullet

Introduction

You may have been having problems with your swallowing and your hospital doctor has suggested that having a stent inserted will help improve these difficulties. This procedure requires your formal consent. This booklet has been written to enable you to make an informed decision in relation to agreeing to the investigation. You will be required to sign a consent form on the day of the procedure, which is a legal document, therefore please read this booklet carefully beforehand.

If you are unable to keep your appointment, please notify the endoscopy unit as soon as possible. This will enable staff to give your appointment to someone else and to re-arrange another date and time for you. You need to understand all the information, including the possibility of complications. There will be the opportunity to speak to a health care professional about anything that you do not understand on the day of the procedure before you sign the consent form.

What is a Gastroscopy with Oesophageal Stent inserted?
A Gastroscopy (which is also sometimes called an Upper Gastro-Intestinal endoscopy) involves putting a tube through the mouth into the oesophagus (gullet), down through the stomach and into
the first part of the intestine (duodenum). By doing this the doctor can examine the upper digestive tract to detect any abnormality. A stent is a flexible, fine, metal mesh tube. It is inserted via the gastroscope into the oesophagus (gullet) and positioned across the area that has narrowed. See picture above.

Are there any alternatives to having a stent inserted?
The aim of the stent is to allow you to swallow more easily again. If you decided against having this procedure and you can no longer swallow the nutrition the normal way; there are alternatives
available, but these are not appropriate for everybody. You’ll need to discuss these with your consultant.

What about my medication?

Routine Medication
If you are on any medication, especially blood pressure tablets, you should take these with a small amount of water as usual.

Anticoagulants/ Antiplatelets
If you are taking blood- thinning medicines, such as Warfarin, Dabigatran, Heparin, Deltaparin, Apixaban, Clopidogrel, the dose of these may need to be altered or stopped before your procedure. You may also need to have blood tests before your procedure. If the referring doctor did not give you instructions, you may be referred to the bridging clinic for advice on stopping your medication. If this is required, this will be arranged for you by the referring clinician or the endoscopy booking coordinator.

What will happen when I arrive?
You will be admitted to hospital on the day before your procedure. Very occasionally, it may be the morning of your procedure. This is so that you can be seen by a doctor and have blood tests taken before you have the procedure. You will be kept nil by mouth for six hours before the procedure. This means no food or drink. This is so that your stomach is empty.

Before you have the procedure, the doctor will ask you to sign a Consent Form. He will explain the procedure again and answer any questions you may have. He will also explain any potential risks.
In preparation for the sedation, which will be given later, the doctor or nurse will insert an IV cannula (a small plastic tube) into a vein in your hand or arm.

Intravenous sedation
A sedative (usually Midazolam) will be administered through the cannula into your vein. It will make you lightly drowsy and relaxed, but not unconscious. This means that you will still hear what
is said to you and therefore, will be able to carry out simple instructions during the procedure. Some people do not remember anything about the procedure once the effects have worn off. Whilst you are sedated, we will monitor your breathing, respiration, and pulse rate via a finger probe, so that any changes can be recorded and dealt with accordingly. You will also be given some oxygen via a nasal sponge into your nostril. Your blood pressure may also be checked and recorded.

The Procedure
When it is your turn you will be taken to the Endoscopy procedure room; you will be introduced to the team and a verbal safety checklist (called “WHO”) will be done. Your throat will be made numb by using the local anaesthetic spray; you will then be asked to lie on your left side. A “probe” will be placed on your finger which can read your pulse and the amount of oxygen in your body (pulse oximeter). Oxygen will be given, usually via a sponge which is placed into one of your nostrils. A mouth guard is placed lightly between your teeth. If you wear dentures these will be removed before the guard is inserted.

The Doctor passes a flexible tube (endoscope) down through your throat, into your gullet and past the narrow area. A guide wire is inserted across the narrowing and then a stent is passed over the
guide wire and position confirmed. Once the doctor is happy with the position, the stent will be released under x-ray control and it will begin to gently expand. The endoscope is then gently passed to confirm the stent is in place. The procedure should take about 20 minutes.

Milton Keynes University Hospital is a teaching hospital and there may be a student and/or a trainee present in the room, or a supervised trainee may be doing your procedure. If you have any
concerns or objections, please contact the Endoscopy Unit prior to your test or make the nurse admitting you aware of this.

Will it hurt?
Sometimes people experience chest or back pain. This can vary and may be only discomfort. This usually settles within a couple of days. Please let your nurse and/or doctor know if you do have discomfort or pain as pain relief medication can be given to help you feel more comfortable.

Aftercare
After your procedure you may have a chest x-ray to check that your stent is in the correct place. The nurse will tell you when you are allowed to have a drink and something soft to eat. This may
be a few hours after you returned to the ward. Before you go home the Dietitian and/or your key worker (your Upper Gastro-Intestinal (UGI) Nurse Specialist) may come and talk to you about types of food you can have and give you some simple tips on how to keep your stent clean. This is mainly about having plenty of fluids to drink, particularly with your meals. Please be aware that there will be some types of food that you will still need to avoid.

Here are some simple tips:
• Sit upright to eat
• 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, consider having smaller and more frequent nourishing meals

Are there any risks?
Having an Oesophageal Stent inserted does have some risks associated with it. These occur infrequently, but we wish to draw your attention to them in order to help you make your decision. The doctor or specialist nurse who has requested the test will have considered this already. The risks must be compared with the benefit of having the procedure carried out. Complications can happen. Some of these can be serious and can even cause death (risk: 1 in 25,000).

The possible complications of gastroscopy are listed below. Any numbers which relate to risk are from studies of patients who have had this procedure. Your doctor will tell you if the risk of
complications is higher or lower for you.

• Sore throat, which gets better quickly.
• Allergic reaction to equipment, materials, or sedative. The endoscopy team is trained to detect and treat any reaction that may happen. Let the admitting nurse and endoscopist know if you have any allergies or you have reacted to any drugs or tests in the past.
• Breathing difficulties or heart irregularities, as a result of reaction to sedation or inhaling secretions such as saliva. To help prevent this from happening, your respiration and oxygen levels will be monitored, and a suction device will be used to clear any secretions. Rarely, a heart attack or stroke (loss of brain function resulting from an interruption of the blood supply to the brain) can happen if you have serious medical problems.
• Aspirating fluid in airway (minor risk)
• Perforation – making a hole in the oesophagus, stomach, or duodenum (risk: between 2% and 5 %). The risk is higher if there are any abnormal narrowing (stricture) which is stretched (dilated). If a hole occurs, you will need to be admitted to hospital for further treatment which may include surgery.
• Damage to teeth and bridgework. The nurse will place a plastic mouthpiece in your mouth to help protect your teeth. Let the endoscopist and nurse know if you have any loose teeth or dentures.
• Bleeding from biopsy site or from minor damage caused by the endoscope. This usually stops on its own.
• Incomplete procedure. This can happen due to a technical difficulty, food or blockage in the upper digestive system, complications during the procedure, or discomfort.
• Sedation. This can occasionally cause problems with breathing, heart rate and blood pressure. If these problems do occur, they are usually short lived. Careful monitoring by the endoscopy team ensures that any potential problems can be identified and treated quickly. Older patients and those with significant health problems, such as breathing difficulties due to a bad chest, may be assessed by a doctor or specialist nurse before having the procedure. You should discuss these possible complications with your doctor if there is anything you do not understand.

What if the stent becomes blocked?
When a stent becomes blocked it normally causes some discomfort or pain, difficulty with swallowing and sometimes regurgitation of food. Try not to panic. The following actions may help:-
• stop eating
• stand up and walk around the room
• take small sips of fizzy drink
• If the blockage persists, contact your doctor or local hospital.

If you have persistent abdominal or chest pain, fever, or bleeding after the procedure, you must then seek urgent advice from the Endoscopy Department between 09:00 and 17:30 (01908 996460). Outside these hours, please call a nurse on Ward 8 (01908 996395) for advice or go to your nearest A&E department.

If you have a cancer you should already have a contact number for your Nurse Specialist. If not, please contact the Upper Gastro-Intestinal (UGI) Nurse on 01908-660033 and ask switchboard to
Bleep 1785.

References for the information contained within this leaflet if required may be obtained by the author.

People are unique and the alternatives, risks and benefits will of course vary from person to person. We hope this leaflet will support the information you have already received from your doctor in enabling you to make an informed decision about your care. If you have any questions, please ask us.