Answer

Oesophageal stent

There is a metallic oesophageal stent which has been inserted in the lower oesophagus. Malignant oesophageal strictures (whether due to intrinsic or extrinsic compression) are the main indication (stents are not indicated for benign disease). Stents are either uncovered, i.e. metal mesh only, or covered with a plastic membrane over the mesh - covered stents. Covered stents can be used to treat malignant oesophageal fistulae. Retrosternal pain can be quite troublesome for few days after stent placement and 291

Fig. 6.27 Colo-rectal stent. The initial image shows a narrow irregular stricture at the junction of the recto-sigmoid colon. The second image is of the metallic stent once in position.

powerful analgesia is often required. Profound gastro-oesophageal reflux usually occurs and anti-reflux medication or acid suppression therapy (proton pump inhibitors, etc.) needs to be prescribed. It is often helpful to elevate the head of the bed. Bolus obstruction can occur and fizzy drinks should be taken following meals to help clear any food debris from around the stent. Tumour ingrowth (particularly with uncovered stents) can be a problem leading to restenosis or occlusion. Covered stents have a membrane over the meshwork to help prevent this happening, although they are more prone to migration. Other complications include oesophageal perforation and stent migration.

Colo-rectal stenting can also be performed, (see Fig. 6.27). This is useful in cases of large bowel obstruction as a definitive palliative procedure or as a temporising measure prior to colonic surgery. The stent decompresses the large bowel obstruction so that elective surgery is possible after formal bowel preparation and work-up. The stent is then removed at surgery with the diseased bowel.

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