Colonic Stenting Your operation explained

Introduction

Contents

This information is for people considering having ‘Colonic Stenting’. It explains what is involved and some possible problems that you need to know about. It is not meant to replace discussion between you and your doctor, but can be used to help you decide whether to have the operation and to prepare for it if you do.

How your digestive system works …..………....page 2 Information about Colonic Stenting to help you make your decision .…page 3 What happens after the stent has been placed..page 8 Glossary ………………….. page 9

If you still have questions after reading this leaflet, please ask the doctor, nurse specialist or your keyworker for more information. The nurse specialist can give you a separate list of organisations that can offer you support. (Staff: delete as applicable)

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Nurse specialist

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How your digestive system works To understand the operation, it helps to have some knowledge of how your body works. When you eat, your food passes from your mouth down the oesophagus (food pipe) into your stomach. Here it is broken down and becomes ‘mushy’. It then goes through the small bowel, a long, coiled tube where nutrients are digested and absorbed. The mushy food is then passed into your colon (large bowel). This is a shorter but wider tube, where it becomes faeces (bowel waste). The colon’s main job is to absorb water, making your bowel waste more solid. The bowel waste then enters your rectum which is like a storage area. When the rectum is full, we feel the need to open our bowels (go to the toilet). The bowel waste passes through your anus (bottom) when you go to the toilet.

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Information to help you make your decision What is a stent?

Why are stents used?

A stent is a hollow tube made of a flexible alloy mesh. Stents can be rolled up tightly to the size of a pen to allow them to be inserted through the blockage in the bowel. Once in place, stents are allowed to expand and therefore keep open the passage through the bowel.

Stents can be used for the following reasons:

Image of a stent

For people whose cancer is potentially curative (able to be cured), if their bowel is obstructed, stents may be used before surgery. The stent aims to allow the bowel to empty and this can make eventual surgery safer.

Stents are suitable for patients who have complete or partial bowel obstruction (blockage). The aim of a stent in these patients is to relieve the obstruction, especially if the patient is not considered suitable for surgery.

What are the benefits of colonic stenting? Stenting relieves pressure within the bowel to allow free passage of faeces. It does not involve a surgical operation. Stenting can be used as an alternative to surgery, in patients who are considered ‘medically unfit’ or who have metastatic cancer (cancer that has spread). These patients can avoid major surgery and the need for a stoma (see below).

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Information to help you make your decision (continued) How is a stent inserted? The procedure is usually performed in the X-ray or endoscopy department. Before the stent is inserted you will need to sign a consent form to say you agree to the procedure. You will be asked to lie on your left side, or face down, on a treatment table. You may be offered a light sedative before or during the procedure to help you relax. The procedure will take from about 20 minutes, but could take longer, depending on your personal circumstances. Sometimes, it may take more than one attempt to put the stent in place, and more than one stent may be needed. Sometimes it is not possible to do the procedure, in which case your doctor will discuss an alternative plan with you.

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Information to help you make your decision (continued) What risks are there? Most people will not experience any serious complications. Your doctor will discuss risks with you. Perforation The procedure may cause perforation (a hole) leading to leakage from the bowel into the abdomen. If this happens, you could need further treatment including an operation. Perforation is unusual but it can be serious and life threatening.

Migration Loosening of the stent could cause it to move. Treatment may include removal of the stent, replacement, surgery or simple observation. Symptoms may include: • Pain and urgency in your bottom • Your previous symptoms of

obstruction coming back.

You should report any such symptoms to your nurse or doctor straightaway.

Malpositioning Positioning the stent may be difficult due to the position of the blockage in your bowel. If positioning is only a part success, a second stent might be added.

Bleeding A small amount of bleeding may occur. This may come from the blockage itself or the stent rubbing against it. Some bleeding is to be expected but if you have heavy bleeding or are still bleeding 24 hours after your stent has been placed, then contact your doctor or nurse.

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Information to help you make your decision (continued) What risks are there? (continued) Pain

Reobstruction

You may have some abdominal (tummy) pain after the procedure. If you are still feeling this pain 24 hours after your stent has been placed, contact your doctor or nurse. If your pain is severe, you should contact your doctor or nurse straight away.

This can be caused by the blockage growing through the stent, blocking the bowel again. If this occurs, you may have symptoms of obstruction (your bowels may stop working, your tummy may become bloated and you might start being sick) or abdominal discomfort and should contact your nurse or doctor. This may mean you need another stent.

Patients who have had a stent placed in their rectum might experience discomfort in their bottom. This is usually tolerated, after an initial period of discomfort.

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Information to help you make your decision (continued) What other options are there? Doing nothing may lead to complete blockage of the bowel. This can be fatal (i.e. cause death). Major surgery may be an option but it could involve more risk. A stoma could be created for you. This means bringing the colon out through an opening on your abdomen (tummy). Bowel waste passes out through this into a pouch or bag that you stick to your tummy. Often in patients who are considered ‘medically unfit’, or who have cancer that has spread (metastatic cancer) the stoma is permanent. Your doctor can talk with you and give you information about your choices.

What would my bowel habits be like after having a stent placed? After this procedure you will have loose (soft) stools because you will need to take long term stool softeners. You may also experience: • Needing the toilet more often • A lack of control of your bowels that may mark your underwear • A sore bottom • Bleeding through your bottom. In most people this improves with time. If this interferes too much, contact your nurse for advice. If necessary, medication and exercises can help to improve your bowel control.

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After the stent has been placed An X-ray might be taken to assess the position of the stent. You may need to stay in hospital for up to 48 hours after the procedure. How is my diet affected? You will need to follow a specific diet for a few days after surgery. Day 1: liquids only Day 2: low fibre foods: pasta, mashed potato, white bread, cereals, soft pudding, ice cream

When you are discharged from hospital It is important to follow dietary guidelines, maintain enough fluid intake and take stool softeners/laxatives as prescribed. Keep an eye on your bowel movements. Report any new pain and / or bleeding to your doctor or nurse right away. Tell any doctor who needs to perform a rectal (bottom) examination on you that you have a stent.

Day 3: start chicken, fish, eggs, cooked vegetables, tinned fruit. You should avoid: • fresh fruit • raw vegetables • fruit or vegetable skins • food with seeds • nuts and • tough meats. You should drink plenty of fluids. Your doctor or nurse will likely recommend stool softeners or laxatives. Some painkillers, particularly morphine, cause constipation. You may need to take laxatives for this (long term).

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Glossary of medical terms used in this information:

Metastatic cancer Cancer that has spread. Obstruction A blockage in the bowel. Perforation A hole in the bowel. Rectum The lowest portion of the large bowel. Bowel waste (faeces) is stored in the rectum until they are passed out of the body through the anus (bottom). Stent A flexible hollow tube made of alloy mesh. Stoma Bringing the colon (bowel) out through an opening on your abdomen (tummy).

About this information This information can be made available on request in alternative formats and in other languages to meet the needs of those who are not fluent in English. This version is available online at http://www.cancerni.net/leaflets. It is provided for general information only and is not a substitute for professional medical advice. We make every effort to ensure that our information is accurate and consistent with current knowledge and practice at the time of publication. NICaN Colorectal Cancer Information Group have created this leaflet for people considering having a colonic stent placed, whether this is because of cancer or not. It was adapted from Pan Birmingham Cancer Network information.

Publication Date: Review Date:

June 2010 June 2012 Page 9 of 9