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Eating AfterEsophageal Stent Placement

This brochure isdesigned to give youinformation aboutdiet and nutrition aswell as helpfulrecommendationsfor caring for youresophageal stent.

What is anesophageal stent?An esophageal stent is a flexible mesh tube, approximately2cm (3/4 inch) wide, and is placed through the constrictedarea of your esophagus (food tube) to allow food andbeverages to pass from your mouth to your stomach fordigestion and absorption of nutrients.The stent gently expands to hold the narrowed area ofthe esophagus open and should make swallowing foodsand beverages easier. The stent will not be as wide or asflexible as a normal esophagus so you will need to takecare with certain foods and in the way you eat to preventblocking the stent.This is an example of what your stent may look like:‹ Esophagus‹ Esophageal Stent‹ Esophageal Stricture or Tumor‹ Stomach

What can I eat?Once the stent has been placed, your medical team willadvise you on when it is safe to start eating and drinkingagain. You will start with fluids and then build up graduallyto a soft diet. It can take one to two days for the stent tofully expand so take it slowly initially.Your healthcare team will let you know how quickly toprogress through the following dietary stages:Stage 1daysFluids only – water, tea, coffee, fruit juices, milk,soft drinks or sports drinks.Start with small sips and increase the volume asyou feel confident.Stage 2daysSmooth or pureed foods, including soup (withoutlumps), applesauce, yogurt, ice cream, puddingor gelatin.Increase the texture of your food to a softconsistency as you feel your swallowing becomeseasier and your confidence builds. You may tryscrambled eggs, cottage cheese, steamed fish,mashed potatoes, mashed banana and pudding.Stage 3Try to include a wide variety of foods and fluidsin your diet so you achieve as close to a normaldiet as possible and to ensure you meet yournutritional needs. If you feel that you cannotachieve this on a soft consistency diet, ask tospeak to a registered dietitian.For meal suggestions, please refer to the last twopages of this brochure.

Are there any foodsI should avoid?The stent has been placed to allow you to eat as normallyas possible. However, it is possible for the stent to becomeblocked. The most common reason for stents to block isfrom food that is swallowed without being sufficientlychewed or from foods that do not break down enoughwhen chewed.The following foods can be difficult to break down, despitechewing, and so are more likely to cause your stent tobecome blocked: Bread and toast Tough gristly meat Hard boiled or fried egg Fish with bones Pithy fruit (e.g., orange, grapefruit, pineapple) Stringy vegetables (e.g., green beans, celery) Potato skins Salad items (e.g., salad leaves and lettuce) Raw vegetables Chips Ice cream or yogurt with chunks of fruit, cereal or nutsTo minimize the risk of blocking the stent, it is importantto think about the foods that you are eating. Some foods,when chewed well, will be easier to swallow than others.For example, bread sticks will crumble when chewed butbread will form a sticky lump.

How can I preventblocking the stent? Take your time, relax and eat your meals slowly. M eals should be smaller than you are used to andmore frequent – aim for five or six small meals ratherthan three big meals. C ut your food into smaller pieces than you wouldnormally eat, take small mouthfuls and chew eachmouthful thoroughly. D on’t be afraid to spit out lumps that can’t be chewed. H ave plenty of sauces, gravy or cream with your meals.It will make your food moist, therefore easier toswallow and pass through your stent. T ake frequent drinks during and after each meal to helpkeep your stent clear. Warm or carbonated beveragesare recommended, but all fluids are beneficial. For somepeople, carbonation may worsen symptoms of heartburnor acid reflux. S it upright at meal times and for one to two hoursafterwards. I f you wear dentures, make sure they fit correctly, so youcan chew your food well. A sk your healthcare team about pills that are hardto swallow.nnn Ask if any of your pills are available in liquid form. sk your pharmacist if crushing your pills is anAoption, as some pills may become less effectivewhen crushed.P ills that can be crushed can be added to applesauceor other soft foods.

What if mystent blocks?If you feel that your stent is blocked follow thesebasic guidelines: D o not panic. The blockage only affects the tube into yourstomach, and it will not affect your ability to breathe. Stop eating, stand up and take a few sips of a drink. I f that does not resolve the problem, try a warm orcarbonated beverage. W alk around.If the stent blockage has not cleared after one or twohours contact your doctor or nurse.Remember it is important to include awide variety of foods of suitable texture togive you all the nourishment you need.

What can I do ifI don’t feel hungry?If you have a poor appetite or have lost some weight, trythe following: Eat small amounts often, including snacks. C hoose full cream milk and full fat foods instead of lowfat products. Add sugar to cereals, puddings and beverages. G rated cheese, cream, sour cream, or cream cheese canbe added to mashed potatoes, soups and sauces. F ortify milk by adding 2-4 tablespoons dried milkpowder to 1 pint of milk. Use this for beverages, soups,puddings and sauces. T ry a protein drink or make your own fruit smoothie ormilkshake using ice cream, yogurt and fortified milk. I f you are lactose intolerant, drink nutritional fruitbeverages such as Boost Breeze, Ensure Clear orNUTRA/Shake Fruit Plus Free. To add calories, blendin lactose-free sherbets, sorbets or popsicles.If you are unable to maintain your weight, a registereddietitian can offer more specific advice and supportor recommend some high calorie nutritious recipes orproducts. If you have not yet met a dietitian, a referralcan be made by your doctor or nurse.

Potential problemsassociated with your stentAcid RefluxThis may be a problem, particularly if your stent needs tobe placed across the opening between the esophagus andstomach. An antacid medication may be helpful (consultyour doctor regarding which one). Try not to sleep too flat.Prop yourself up to a 30-45º angle. Try using pillows or abed wedge. Both can be placed between the mattress andbox spring to raise the head of your bed. If you continueto experience problems, contact your healthcare team.PainAs the stent expands it can cause some pain in thechest area, which normally subsides after 72 hours.Painkillers should be helpful. However, if the pain persistscontact your healthcare team.Persistent Swallowing ProblemsIf your ability to swallow does not improve despitefollowing the advice in this booklet, it may be because thestent is not in the correct position or has moved. Contactyour healthcare team for advice. You should also seekadvice if swallowing food and beverages causes you tocough, or if you experience any breathing difficulties, ifyou are losing too much weight or become dehydrated.

Meal suggestionsBelow are some suggestions of suitable foods and mealideas for once you have progressed to stage 3 of your diet.This list is intended as a guide, and you may include otherfood items that you can chew well enough to swalloweasily with your stent. Remember to chew all foods welland eat small and frequent meals and snacks.Breakfast Pancakes/waffles softened with butter and syrup O atmeal, or other hot cereal made with whole milk andsugar, honey, or maple syrup S oft fruit, for example ripe banana, apple or other fruitsauce or stewed pears Thick and creamy yogurt Fruit juice Scrambled or poached eggs Cereal (e.g., Rice or Cocoa Krispies or Cheerios )Dinner Macaroni and cheese Tender or ground meat in gravy, for example shepard’spie, corned beef hash, chicken stew Boneless fish with butter, tartar sauce or mayonnaise Tender or ground meat or vegetable curry with rice Buttered noodles Shredded or ground turkey or roast beef served withmashed potato with added butter, cream or cheese Soft, well cooked vegetables, such as carrots,peas or spinach Spaghetti with ground meat sauce

If you have trouble maintaining your weight: Drink nutritional supplements or homemade milk shakesas snacks / meal replacements. Try adding ice cream, sherbets, sorbets to ready-madesupplements such as Nutra-shakes , Ensure or Boost . Ifit is too sweet, dilute with whole milk or evaporated milk. I f you have pills to take, consider taking them withcalorie-containing beverages instead of water.For more ideas, speak to your healthcare team.Lunch or Snack B aked potato (no skin) with butter and soft filling, suchas chili with fine meat pieces, cream cheese, gratedcheese or cottage cheese S oup with added cream, cheese, skimmed milk powderor tender meat C anned fruits Q uiche or omelette made with cheese, spinach or othercooked vegetables T una, egg, chicken or ham salad made with a lot ofmayonnaise or plain yogurtDessert P udding, rice pudding or custard T hick and creamy yogurt I ce cream, sherbet or sorbet M ousse C rème caramel or flan M ilky drinks, for example, milky coffee, hot chocolateor malted drink P lain, soft cake, such as sponge, angel food, or pound F rozen yogurt

Names and Contact InformationIf you have any questions about eating with your stent contactyour healthcare team.Registered Dietitian:Doctor:Nurse:Endoscopy Unit:Additional ResourcesUniversity of Virginia Health CenterMedicine Nutrition Support Teamwww.ginutrition.virginia.eduOhio State University Medical Centerhttps://patienteducation.osumc.edu (search for “high calorie diet”),614.293.3191Esophageal Cancer Awareness Association (ECAA)http://www.ecaware.org/800.601.0613Boston Scientific does not provide medical advice, diagnosis or treatment. The contentsof this brochure (“Content”) is for informational purposes only. The Content is notintended to be substitute for professional medical advice, diagnosis, or treatment.Always seek the advice of your physician or other qualified health care provider withany questions you may have regarding a medical condition.All trademarks are property of their respective owners.CAUTION: The law restrictsthese devices to sale by or onthe order of a physician.Indications, contraindications,warnings and instructions foruse can be found in the productlabelling supplied with eachdevice. Information for use onlyin countries with applicablehealth authority registrations.Material not intended for use inFrance.CAUTION: US Federal lawrestricts this device to sale by oron the order of a physician. 2017 Boston Scientific Corporationor its affiliates. All rights reserved.ENDO-180605-AB October 2017

ideas for once you have progressed to stage 3 of your diet. This list is intended as a guide, and you may include other food items that you can chew well enough to swallow easily with your stent. Remember to chew al