Metal Stents in Gastroenterology

Kirsten Rosser, RNGastroenterology Department

Outline

History What is a metal stent? Placement Indications for use Insertion Complications After care

History of GI Stents

1973 Didcott (Oesophageal)

1985 Carrasco (Biliary)

1991 Dahmato (Colorectal)

What is a Metal Stent?

Where do we place them?

Oesophagus

Oesophageal Stents - indications Palliative care in patients with malignant

obstruction of the oesophagus Increase in nutritional intake Minimise risk of aspiration

Where do we place them?

Oesophagus Duodenum

Duodenal Stents - indications

Palliative treatment for obstruction of the duodenum

Facilitates gastric emptying Decreases nausea and vomiting Avoid palliative surgery

Where do we place them?

Oesophagus Duodenum Bile duct

Biliary Stents - indications

Infiltrating tumours Palliative treatment of bile duct

obstruction Relieve symptoms of jaundice Ascending Cholangitis

Where do we place them?

Oesophagus Duodenum Bile duct Colon

Colonic Stents - indications

Immediate bowel decompression

Palliative treatment of large bowel obstruction

Decreased surgical morbidity

Shorter hospital admission

Decreased costs compared to colostomy/resection

Preparing the patient

Information leaflets Explaining the procedure Answering any questions Obtaining informed consent

During the procedure - the nurses role Monitoring vital signs Assessing patient comfort Maintaining patient dignity Assisting the Doctor with placing stent

How is the stent deployed?

Complications associated with stent placement Perforation pain bleeding stent migration tumour ingrowth/overgrowth fistula formation/ulceration

Care of the patient post stent insertion - immediate NBM for 2 hours Hourly observations - BP and pulse Assess for pain Clear fluids after 2 hours if no pain Liquid diet after 4 hours Soft diet after 24 hours Notify Dr if any pain, bleeding or change in

observations

Care of the patient post stent insertion - longer term Dietician referral Position while eating (Oesophageal) Patient Information leaflets What happens if the stent blocks?

Questions?