1. THE ROLE OF THE RADIOLOGY
SPECIALIST NURSE AND
OESOPHAGEAL CANCER PATIENTS
Angie Marriott
Radiology Specialist Nurse
Academic Department of GI Radiology South Manchester University
Hospitals NHS Trust

2. How oesophageal cancer patients were
previously managed
• Procedure done in radiology
• Patient left the department
• No follow up
• No data on problems post stent insertion

3. Radiology department
• Excellent rapport with the multi- disciplinary
team
• Provides an excellent service
• Effective in communicating and liaison

4. Patient information and research
• Data collected on all patients
• All interventional procedures are audited for
complications
• Research studies conducted within radiology

5. Audit and Research
• Collate patient information for BSIR
Oesophageal stent registry
• Contribute to National Audit/Research and
multi- centres

6. Role of the specialist nurse
• Visit all patients pre and post procedure
• Consistent point of contact
• Ability to deal with patients’ problems
• Follow up in the community
• Further intervention
• Specialist knowledge
• Consent

7. Patient information leaflet
• All patients given information leaflet
• Written based on following up 400 Patients
• Reassures patients
• Provides advice post stent insertion

8. Integrated Care Pathways
• All patients are commenced on Integrated
Care Pathway
• Provides a continuous approach to patient
care
• Consistency
• Excellent guidelines and advice

9. Self expandable metal Stents
(SEMS)
Modern
• Retrievable stents
• Anti migration stents
• Anti reflux stents
Indication
• Malignant oesophageal obstruction

10. Anti-reflux Stents
• Tumours across GOJ
• Acid Reflux reduced
• Research conducted

11. Types of tumour
• Adeno carcinoma
• Squamous Carcinoma

12. Tumour sites
• Upper
• Middle
• Lower

13. Indications
• Oesophageal malignant obstruction
• TOF
• Benign stricture
• Pre- surgery

14. Patient assessment
• Referral
• Assessment of dysphagia
• Barium swallow
• Results
• Treatment

15. Dysphagia score definition
0 = No dysphagia
1 = Dysphagia with some solids
2 = Able to eat semi solids
3 = Able to swallow liquids only
4 = Complete dysphagia

16. Role of the dietician
• Reason for referral
• Weight-loss
• Aspiration
• Assess nutritional status

17. Role of the Speech and Language
Therapist
• Reason for referral
• Assessment of swallowing
• Guidance
• Treatment and advice

18. Stent placement
radiology department
– All stents placed using fluoroscopy
– O2
– BIS monitor
– BP/P, SAT
– Radiology nurse
– Sedation
– Analgesia

19. Immediate post procedural care
• Recovered in radiology recovery BP,P O2
• Radiology recovery nurse
• Post procedural pain monitored
• Observing
• Nausea/vomiting
• Bleeding
• Aspiration

20. Problems post stent insertion
• Pain
• Nausea/vomiting
• Dysphagia
• Acid Reflux
• Fears of stent failure

21. Nurse follow up post stent insertion care
• Visited by specialist nurse
• Dysphagia score
• Pain
• Acid reflux
• Nausea/vomiting

22. Failure
• Migration
• Overgrowth
• Perforation
• Food impaction
• Insufficient expansion
• In growth

23. Complications requiring procedural
re-intervention
• Stent migration
• Food bolus obstruction
• Tumour overgrowth/in growth

24. Re-intervention
• Barium swallow
• Gastroscopy
• Overstent
• Re stent
Lymph
Node

25. Re-interventional options
• Re - stent
• Re positioning stent
• Exchange stent
• Balloon dilate dilatation
• Endoscopy
• Gastrostomy

26. Nurse follow up post stent insertion
• Visited by RadiologySpecialist Nurse
• pre and Post procedure
• Follow up in community
• Telephone contact given
• Pts telephoned regularly
• Choose and book

27. Role of the Radiographer Practioner
• Provides an excellent link
• Reduces patient s waiting
• Available for swallows

28. Pre op Service and Admission
Lounge
• New pre op service set up
• Streamlines all patients
• Enables assessments pre procedure
• Opportunity to deal with any medical
issues
• Timely
• Cost effective
• New Admission Lounge

29. www.smuhtrad.nhs.uk
Thank you