Indications, contraindications, postoperative management, and precautions for gastrointestinal stents

Indications

1. Primary and recurrent cancerous gastrointestinal strictures that cannot be removed.

2. Patients with advanced cancerous gastrointestinal strictures who cannot tolerate surgery.

3. Patients with digestive tract stenosis caused by malignant tissue infiltration or compression.

4. Benign gastrointestinal stenosis.

5. Acute cancerous obstruction, such as acute colorectal cancer obstruction.

6. Malignant obstructive jaundice, preoperative jaundice reduction, and palliative treatment for advanced patients.

7. Postoperative anastomotic fistula, such as postoperative biliary fistula.

8. Esophageal tracheal fistula, colorectal cancer combined with intestinal fistula and pancreatic fistula.

9. Bile duct stones, such as large stones, cannot be successfully removed by endoscopic lithotripsy.

10. Bile duct drainage, such as temporary drainage for patients with acute cholangitis who are not suitable for stone removal.

11. Patients with pancreatic pseudocysts, pancreatic schizophrenia, pancreatic ascites, and chronic pancreatitis with pancreatic duct stones.

12. Refuse colostomy, agree or request stent treatment

Contraindications

1. Coagulation dysfunction and untreated oral anticoagulant drugs.

2. Patients with poor general conditions and intolerable cardiopulmonary dysfunction.

3. Suspected patient with digestive tract perforation.

4. Clearly identify patients with extensive abdominal metastasis, multiple stenosis or excessively long stenosis site, and estimated inability to alleviate with 1-2 stents.

5. Severe portal hypertension with esophageal and gastric varices or a tendency for severe bleeding.

6. Colorectal obstruction caused by various benign diseases such as Crohn's disease, intestinal tuberculosis, congenital megacolon, etc.

7. Patients with postoperative anastomotic stenosis (excluding those with anastomotic recurrence and distant metastasis that cannot be surgically removed).

8. Hilar bile duct tumors and multi-level branch bile duct obstruction in the liver result in poor drainage effect and should be used with caution.

9. During acute or chronic pancreatitis attacks.

10. Those who are unwilling to accept stent implantation.

Postoperative treatment and precautions

1. Postoperative treatment

(1) Eat liquid food early after surgery, eat small and multiple meals, and avoid eating dry and hard foods to prevent stent blockage.

(2) After surgery, treatment such as anti infection, acid suppression, and fluid replacement can be given. Individuals who have inserted nickel titanium alloy stents should not consume excessively cold food to prevent deformation and displacement of the stent.

2. Common complications and management

(1) Bleeding: Gastrointestinal bleeding is generally treated conservatively, and if necessary, endoscopic hemostasis is performed.

(2) Perforation: Once discovered, emergency surgical treatment is required.

(3) Infection: If a biliary infection occurs, the drainage site should be adjusted again under endoscopy or the nasobiliary duct drainage should be replaced.

(4) Stent blockage: caused by food, fecal impaction, and proliferation of granulation or tumor tissue. The former can be cleared with a probe or expansion tube, while the latter can place a second stent.

(5) Stent displacement: The stent can be removed under endoscopy, and surgical treatment may be necessary.

(6) Hyperamylasemia and pancreatitis: Administer medication to treat pancreatitis, closely observe changes in the condition, and if conservative treatment for severe pancreatitis is ineffective, surgical intervention should be performed