Colonic stenting

A colonic stent is a small metal tube — like a tiny wire mesh scaffold — that is placed inside your blocked bowel to prop it open. It is positioned using a camera (a colonoscope) and X-ray guidance at the same time, so there is no need for a large incision. Once in place, the stent gently expands and restores the flow through the bowel.

Stenting is used for two distinct purposes, which it helps to understand from the outset:

• Your large bowel has become suddenly blocked by a colorectal cancer, and a stent is needed to open it up while surgery is being planned ("bridge to surgery")
• Surgery is not the right option for you right now, and a stent can relieve your symptoms and maintain your quality of life (palliation)
• The cancer has come back at a previous bowel join and is causing a blockage
• A narrowing (stricture) in the large bowel from a non-cancerous cause, in selected cases
• You were admitted as an emergency with a blocked bowel and the team wants to avoid an emergency operation and an end colostomy (the alternative — a Hartmann's procedure — would mean major open surgery and a stoma)
• You need a few weeks to build up your nutrition and fitness before a major cancer operation

• Avoids emergency surgery — and the emergency colostomy (bag) that often comes with it
• Gives your body and your medical team breathing room: time to do full staging scans, improve your nutrition, and plan the safest surgical approach
• In published series, technical success is achieved in more than 9 in every 10 cases
• No large incision — the stent is placed through the bowel camera, so you just need sedation, not general anaesthesia
• Hospital stay is typically shorter than after emergency open surgery (where the alternative is often a Hartmann's procedure with an end colostomy)
• For patients who aren't having surgery, stenting can allow you to eat normally and avoid a permanent bag

• Stent migration — the stent can occasionally slip out of position, which happens in about 1 in 10 cases. It can usually be repositioned or replaced.
• Perforation (a small tear in the bowel wall) — this is the most serious risk, occurring in published series in around 3–7% of cases. The risk is higher if you're on a chemotherapy drug called bevacizumab. If this happens, it requires urgent treatment.
• Re-obstruction — the stent can become blocked again as the tumour grows through the mesh. This happens in roughly 1 in 7 patients by 6 months and can usually be treated by placing a second stent inside the first.
• Bleeding — uncommon and usually minor.
• Discomfort from the stent expanding — some patients feel pressure or cramping for a day or two after the procedure. This typically settles on its own.
• Theoretical concern about tumour spread — some research has raised questions about whether stenting before surgery might allow small numbers of cancer cells to spread. This is still debated by experts and will be discussed with you if it's relevant to your situation.

If you take blood thinners, diabetes medication, GLP-1 weight-loss injectables, or iron supplements, please flag this when you book — these need specific adjustments before the procedure. Full details are in the guide above.

• You'll be admitted to Warringal Private Hospital — because your bowel is blocked, this procedure is nearly always done as an inpatient
• A drip (IV fluids) will be started to rehydrate you and correct any salt imbalances
• A CT scan of your abdomen and pelvis will be done to see exactly where the blockage is and plan where to place the stent
• Blood tests will be taken, including checks on how well your blood clots
• The procedure, the risks, and the alternatives — including emergency surgery (typically a Hartmann's procedure) — will be talked through with you, so you can give informed consent
• Where time and the clinical situation allow, your case is reviewed by the colorectal and oncology multidisciplinary team (MDT) before the stent is placed. In a true emergency the stent may need to be placed first and the MDT discussion follows shortly after.

• Sedation (relaxing medication through your drip) is given by the anaesthetist so you are comfortable and drowsy throughout — you will not need a general anaesthetic
• A colonoscope (a flexible camera) is gently guided through the bowel to reach the blockage, while X-ray guidance (fluoroscopy) is used at the same time to help with precision
• A fine wire is passed through the narrowed area under X-ray to create a pathway
• The stent is placed over the wire and deployed — it opens up on its own, like a spring, and holds the bowel open
• The stent's position and that the blockage has been relieved are both confirmed before finishing
• You will be monitored in hospital afterwards, and your diet will be slowly built back up as your bowel starts working again

• Day 0–1: You'll be monitored closely for any signs of complications such as pain, bleeding, or perforation. Most patients feel relief from their blockage symptoms quite quickly.
• Days 1–3: Your bowel should progressively start working again. Fluids are introduced first, then soft food, and then a normal diet as you tolerate it.
• Going home: Most patients are ready to leave hospital within 3–7 days, depending on how things settle.
• Post-procedure review: A clinic review is routinely arranged 2–6 weeks after the stent (in addition to any oncology team review). This review is provided at no charge.

This depends on which pathway your stent is part of:

If the stent is a bridge to surgery

Your oncology team will complete the staging scans and the colorectal/oncology MDT will meet to confirm the plan for your operation, usually 3–6 weeks after the stent. This is the window in which your nutrition, fluid balance, and overall fitness are built up to support a safer operation. The likely operation is an anterior resection, right hemicolectomy, or another resection from the Bowel Cancer Surgery family, depending on where the cancer sits. The specific operation that applies to you will be talked through at your consultation.

If the stent is palliative

You will be reviewed in clinic with Mr Nguyen and, where relevant, your oncology team. The stent stays in place and you live with it. The following section covers what that involves day-to-day.

If you go home with a stent in situ — most often in the palliative pathway, but sometimes also during the bridge-to-surgery window — a few simple precautions help things go smoothly:

• Diet — eat soft, well-chewed foods. Avoid the items most likely to obstruct the stent: stringy foods (celery, asparagus stalks, fibrous greens), tough meat, nuts, popcorn, large pieces of skin or seeds, and anything you can't chew thoroughly. A simple test: if it would be hard to swallow whole, it might be hard for the stent too.
• Stay well hydrated and keep bowel motions soft — a gentle laxative (such as Movicol or lactulose) is often recommended to keep things moving freely through the stent. The most suitable regimen will be advised at your consultation.
• Watch for warning signs — increasing abdominal pain, persistent bloating, vomiting, or a sudden drop in your bowel motions can mean the stent is blocking or has slipped. A small amount of bleeding from the back passage is not unusual; significant fresh bleeding is not, and needs attention.
• If any of those warning signs occur — call our rooms straight away, or if you are unwell, go to the nearest emergency department. Re-obstruction can usually be managed by placing a second stent inside the first, but it needs to be assessed promptly.

Ongoing clinic follow-up keeps an eye on the stent and coordinates your care with your oncology team.

Post-operative concerns: Please call our rooms on (03) 9816 3951 and leave a message — this will be sent directly as a text to Mr Nguyen. Alternatively, you may text the office mobile on 0499 090 126. We aim to respond promptly during business hours.

Emergencies: For any life-threatening emergency, call 000 immediately or go to your nearest emergency department. Do not wait for a call back from our rooms. For the Austin Hospital Emergency Department: (03) 9496 5000.