What is an oesophageal stent?

An oesophageal stent is a flexible, metal, mesh tube which is placed in the oesophagus (food pipe) when there is a blockage or narrowing. The aim of the stent is to make swallowing easier and more comfortable, allowing food to pass through the oesophagus without getting stuck.

An oesophageal stent is placed into the oesophagus during an endoscopy and positioned in the area that has a blockage or is narrowed.  It gently expands to allow fluid and foods to pass into the stomach more easily.

 

How will I feel after the stent insertion?

The numb feeling in the throat wears off after an hour or so. A chest x-ray will be performed to confirm the position of the stent. Following review of the chest x-ray, fluids will be introduced slowly. As the stent expands, it can cause some pain in the chest area, which normally improves after 72 hours. Over the counter painkillers such as paracetamol can be helpful, however, if pain persists please contact your specialist nurse or doctor.  If your ability to swallow does not improve despite following the advice in this patient information leaflet, please contact your specialist nurse or doctor.

 

When can I eat after the stent is placed?

You should be able to drink 2 to 4 hours after the procedure.  Starting with fluids only you can progressively build up the consistency of the foods you eat until you are able to manage a soft diet.

 

Re-introducing fluids and food

In order to establish which consistency of food is best going to suit you, foods should be gradually re-introduced in stages.  This process will enable you to gain confidence with eating and drinking again.

There are 3 stages:

• Fluids
• Smooth/Purée diet
• Soft diet

The consistency of food that people can tolerate varies between individuals. This depends on the extent of the blockage or narrowing in the oesophagus and how confident you feel about trying different consistencies of food. Once you are confident with a particular stage you will be able to try the next stage.

 

Stage 1: Fluids

Immediately after you have had your stent inserted, it is recommended that you follow a liquid diet. A liquid diet has a smooth pouring consistency and is free from lumps.

• Sips of water, squash, tea, coffee, fruit juice (smooth), full fat milk.
• Try to include full cream milk fortified with milk powder (to make; add four tablespoons of dried milk powder to one pint of full fat milk and mix well).
• Take your time when drinking fluids.
• If this is tolerated, progress to strained soup (no lumps), ice cream, smooth yoghurt and custard.
• You should follow this stage for 24 hours. After 24 hours, you may feel ready to progress to the next stage.

 

Ideas for nutritious drinks:

• Drinks made with full cream milk – coffee, hot chocolate, Ovaltine or Horlicks.
• Fortified full cream milk (see recipe above).
• Milkshakes with ice cream flavourings.
• Complan or Build Up.
• Yoghurt drinks.
• Ice cream can be added to fizzy drinks.
• Oral supplement drinks if you are prescribed these – your dietitians can advise.

 

Stage 2: Smooth/Purée diet

After 24-hours, if liquids are tolerated, foods can be reintroduced starting with a purée diet. A blender or food processor can be used for blending foods.

• A puréed diet should be lump free and have a smooth consistency.
• It can include mashed vegetables, puréed fruit, milky porridge and Weetabix with milk.
• It is also possible to blend meat, fish and eggs. This is made easier by adding gravy or sauce when blending.
• If you are an inpatient at the hospital, you can select the purée option from the hospital menu.

 

Other ideas for foods of purée consistency include:

• Ice cream or sorbets.
• Pureed fruit served with cream, ice cream or custard.
• Smooth yoghurts, custards and mousses.
• Mashed or sieved vegetables.
• Blended or strained soups.
• Gravy or sauce to food when blending. Avoid adding additional water as this will reduce the flavour and nutritional content.
• Extra butter, cream or cheese to food to add more energy.
• Fibre foods pureed such as Weetabix, pureed fruit and vegetables, beans and lentils to prevent constipation.

 

In addition:

• Remember to have plenty of fluids across the day – six to eight cups daily, try to include full cream milk where possible.
• Extra flavouring, such as herbs and spices, smooth mustard and bottled sauces.
• Presenting pureed food on a plate using an ice cream scoop or piping it through different nozzles or in different shapes using moulds, e.g. jelly moulds.

Tip: Liquidise/strain soups and meals to ensure there are no lumps of food or powder. Potato can be liquidised separately using milk to dilute. Vegetable portions can also be liquidised separately using stock or milk when blending to make it more nutritious.

If you tolerate smooth/purée food you can progress to stage 3 soft diet.

Stage 3: Soft diet

A soft diet should need little chewing and should be able to be mashed with a fork or broken into pieces with a fork. All food should be very soft, without lumps before being swallowed.

• Chop or mash foods finely at first and afterwards use plenty of gravy, sauces, cream or cream cheese to adjust the consistency so it is easier to swallow.
• Try having high fibre foods such as stewed fruit and vegetables, Weetabix, beans and lentils to help prevent constipation.
• Have plenty of fluids across the day; six to eight cups daily, trying to include full cream milk where possible.
• Check all foods for bones and skin and remove these. If you are unsure about when to progress through the stages, please contact your medical team.

Soft meal ideas

• Breakfast – porridge, Rice Krispies, cornflakes, creamy yoghurts, stewed fruit and cream, scrambled egg, omelette with cheese.
• Lunch – soup with no lumps (i.e. cream of chicken, tomato or blended soups), mashed baked beans, mashed potato, jacket potato (no skin), tinned fish, e.g. salmon, tuna with some white sauce, pasta with sauce, ravioli, finely mashed egg with lots of butter or margarine, cauliflower cheese (well-cooked in lots of sauce).
• Main meal – fish in sauce, fish pie, spaghetti in tomato sauce, macaroni cheese, cheese soufflé, broccoli or cauliflower cheese, corned beef hash, cottage pie, casserole or stews, tuna in white or cheese sauce, shepherd’s pie, pasta with bolognaise sauce, chilli con carne and rice, curry and rice.
• Desserts – custard, semolina, Instant Whip, mousse, ice cream, rice pudding, stewed fruit with custard, sponge and custard, pot desserts such as yoghurt, crème caramels, trifle or mousse, Ice cream, jelly, tinned fruit.
• Snacks – milkshakes, biscuits dipped in drinks, yoghurt, mousse, soft fruit, Meritene or Complan.

It is important to include a variety of foods of a suitable texture in order to give you all the nourishment you need.

Ideas to enrich your diet

Eating little and often is the best way to increase your calories – try to eat something every two to three hours. Foods can be fortified to make them more nourishing and aim to follow a high calorie, high protein diet without increasing the size of the portion.

The following may be useful:

• Add butter, spread, cream or cheese to mashed potato.
• Add grated cheese to soup, scrambled eggs, baked beans, spaghetti, omelettes, vegetables or sauces.
• Add cream, ice cream, or syrup to puddings and tinned fruit.
• Serve meals with creamy sauces.
• Choose full fat products such as thick and creamy yoghurts and milky puddings such as custard, rice pudding, mousse and crème caramel.
• Use mayonnaise, salad cream, coleslaw and dressing – add to sandwiches and salads.
• Add a scoop of ice cream to cold drinks.
• Add pesto/hummus to pasta.
• Use peanut butter with toast or bread.
• Fortify milk by adding 4 tablespoons of skimmed milk powder to full fat milk – this can be used throughout the day in breakfast cereals, sauces, puddings, soups, jellies and other desserts.
• Use plenty of sugar/honey/syrup on cereals, in hot drinks and puddings.
• Use milk instead of water to make packet or condensed soups, jellies and desserts.
• Choose full fat products such as thick and creamy yoghurts.

Nutritional supplements

Your dietitian may recommend nutritional supplement drinks to you, if you are losing weight and not able to meet your nutritional requirements through your normal diet; these are available in a range of consistencies and flavours.

These are high calorie drinks which also contain protein, vitamins and minerals. There are different types and flavours so it is worthwhile trying different ones to see which suits you best.

There are some nutritional supplements that can be bought over the counter. Examples are Complan and Meritene, which are available in most pharmacies and supermarkets. If you are concerned about your weight, please contact your dietitian for further information and advice.

How to prevent the stent from blocking

It is also important to take time at mealtimes and eat little and often, aiming for 5 to 6 small meals daily. Always sit upright at mealtimes and for half an hour afterwards. Having drinks during and after meal may help foods to move more easily through the stent. Certain foods may increase the risk of the stent blocking; the table below gives information on these and provides suitable alternatives.

	Foods to avoid	Suitable alternatives
Fruit	Pineapple, fruit skins and pith, e.g. from oranges, grapefruit, etc., dried fruit	Soft peeled fruits, stewed/ tinned fruits, fruit juice
Vegetables	Green salads and raw vegetables, stringy vegetables, e.g. green beans, lettuce, sweetcorn, onions, celery, okra seeds and skin of tomatoes	Soft, well cooked vegetables Mash/pureed vegetables if needed, seedless/skinless tomatoes, or tinned tomatoes
Eggs	Fried egg whites and hard boiled eggs	Other eggs, including poached, soft boiled, omelette, soufflé, and scrambled
Meat	Tough meat and gristle, large chunks of meat, dry meat, poultry	Soft, tender meat, stewed meat, minced meat, dahl
Dairy	Chunks of cheese	Grated cheese
Fish	Fish with bones, fish skin, battered fish/dry fish	Boneless fish, poached, steamed, and boil in the bag fish
Bread and Cereals	Soft fresh bread, crusty dry bread, white bread and toasts, chapatti, coarse cereals, e.g. muesli, All Bran, Shredded Wheat, any cereals with dried fruit/nuts	Thinly sliced brown bread removing any crust, with plenty of topping. Weetabix, Rice Crispies, porridge, cornflakes, crackers
Potatoes and starchy carbohydrates	Chips, crisps, yams, plantain, green banana	Mashed potato, jacket potato without the skin, well cooked pasta and rice with sauce, tinned spaghetti
Desserts	Dry cakes, biscuits, popcorn	Jelly, ice-cream, custard, yoghurt, biscuits (dipped in drinks)
Other	Nuts, coarse marmalade	Shredless marmalade

 

What to do if your stent becomes blocked

• Remain calm and try not to panic.
• Stop eating and take a few sips of a drink – warm or fizzy drinks are often useful to relieve blockages.
• Try standing up and walking around.
• Try this over several hours as it can take time for the blockage to be relieved.
• If after 24 hours, you are still not able to swallow food or fluid, contact your medical team or the Endoscopy Unit.

Acid reflux

This is a common issue post-insertion because the stent is placed across the opening between the oesophagus and the stomach. Your doctor may prescribe an antacid medication to help this.

In summary, you may find it helpful to:

• Eat slowly and try to relax as much as possible.
• Take your time with meals and chew your foods well.
• Food should always be eaten sitting upright and you should remain sitting for one hour after eating.
• If you wear dentures, make sure they fit properly.
• If you have problems with reflux, your doctor can prescribe anti-reflux or antacids to help with this problem.
• Drink small amounts of warm or fizzy fluid before, during and after meals to assist in flushing food through the stent (hard swallows).
• Avoid drinking large amounts at mealtimes as this will fill you up.
• Use herbs and spices to add more flavour to foods.
• Try to include favourite or fancied foods appropriate for your stent to promote food enjoyment.

Useful contacts

OPA Cancer charity, Oesophageal and Gastric Support  0121 704 9860

(Monday to Friday, 9.00am to 5.00pm)

www.opa.org.uk

Macmillan Cancer Support 0808 8080 2020

www.macmillan.org.uk

ULTH Macmillan Upper GI Nurse Specialist: [email protected]

Department of Nutrition and Dietetics

Lincoln County Hospital                 01522 573418          [email protected]

Pilgrim Hospital, Boston                 01205 445487          [email protected]