1. Metal Stents in Gastroenterology Kirsten Rosser, RN Gastroenterology Department

2. Outline n History n What is a metal stent? n Placement n Indications for use n Insertion n Complications n After care

3. History of GI Stents n 1973 Didcott (Oesophageal) n 1985 Carrasco (Biliary) n 1991 Dahmato (Colorectal)

4. What is a Metal Stent?

5. Where do we place them? n Oesophagus

6. Oesophageal Stents - indications n Palliative care in patients with malignant obstruction of the oesophagus n Increase in nutritional intake n Minimise risk of aspiration

7. Where do we place them? n Oesophagus n Duodenum

8. Duodenal Stents - indications n Palliative treatment for obstruction of the duodenum n Facilitates gastric emptying n Decreases nausea and vomiting n Avoid palliative surgery

9. Where do we place them? n Oesophagus n Duodenum n Bile duct

10. Biliary Stents - indications n Infiltrating tumours n Palliative treatment of bile duct obstruction n Relieve symptoms of jaundice n Ascending Cholangitis

11. Where do we place them? n Oesophagus n Duodenum n Bile duct n Colon

12. Colonic Stents - indications n Immediate bowel decompression n Palliative treatment of large bowel obstruction n Decreased surgical morbidity n Shorter hospital admission n Decreased costs compared to colostomy/resection

13. Preparing the patient n Information leaflets n Explaining the procedure n Answering any questions n Obtaining informed consent

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

15. How is the stent deployed?

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

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

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

21. Questions?