Nursing care of endoscopic direct vision memory alloy stent for esophageal stenosis 3.1 Preoperative care 3.1.1 Indications Stent placement is appropriate for patients with anastomotic stenosis, esophageal cardia cancer stenosis without surgical indications or refusal of surgical treatment, especially post-radiation stenosis and esophageal tracheal fistula. For smooth tube placement and not affecting the function of epiglottis after tube placement, the distance of the upper edge of the lesion or fistula from the upper esophageal orifice should be more than 4 cm. [3] A thorough medical history should be taken, with special attention paid to any history of allergy to anesthetic drugs. Blood routine, bleeding time, clotting time and prothrombin time should be checked to exclude bleeding disorders. Shao Xianyu, Department of Gastroenterology, Affiliated Hospital of Taishan Medical College 3.1.2 Patient guidance Because memory alloy stent placement is a new technology carried out in recent years, the patient lacks understanding of this, and is prone to nervousness, fear and misgivings, worrying about foreign body sensation after stent placement. We patiently do a good job of explaining the purpose and significance of stenting, introducing the performance of the stent and the basic operation process, introducing the previous treatment experience and successful cases to eliminate the patient’s doubts. We often ask patients to introduce their personal feelings after tube placement or play the video of tube placement is more effective. The patient’s close cooperation is an important factor in the success of tube placement, preoperative to the patient to explain the essentials of cooperation, insertion of the device against the upper esophageal orifice, swallowing action is conducive to the insertion of the device into the esophagus; in the operation of the rest of the time the patient is asked to try to avoid swallowing action, in order to avoid choking and coughing to affect the operation or lead to aspiration pneumonia; dilation and placement of the tube, the patient will be mildly uncomfortable, such as obvious discomfort, can be used to gesture to indicate that, but can not speak. The patient will have mild discomfort during dilatation and tube placement. When exposing the stent, keep the head and neck position unchanged for accurate tube placement. 3.1.3 Patient preparation Fasting for more than 8h before operation, intramuscular injection of scopolamine 10min before operation, intramuscular injection of Valium for those who are overly nervous, anesthesia of lubricating analgesic gel to lubricate the pharynx, and the patient lying on the left side. 3.2 Intraoperative cooperation Intraoperative close cooperation between doctors and nurses is one of the basic factors for the success of treatment, such as intense nausea of the patient during the operation, the patient’s fingers can be pressed to alleviate nausea by pressing the patient’s acupoints such as Hegu. Observe the dental cushion at any time to prevent dislodgment. When the stent marks the upper edge of the lesion, fix the fixation rod and slowly withdraw part of the tube sheath. At this time, 50℃ hot water was sprayed to the stent through the water-filled catheter to quickly restore its designed shape and fix it in the stenosis. If active bleeding occurs during the procedure, immediately dissolve thrombin to stop bleeding in time microscopically. If the stent is placed in an inappropriate position or dislodged into the stomach, 0-5℃ saline can be sprayed to the stent through the water-filled catheter to soften the stent, and the position of the stent can be adjusted or removed using a foreign body clamp or a circler. 3.3 Postoperative care 3.3.1 Diet Immediately after operation, drink a small amount of hot water, so that the stent can completely restore the designed shape and firmly fixed in the stenosis. Fasting for 12h after the operation, and gradually transition to semi-liquid diet or general food. Patients eat less before surgery due to dysphagia, but once the stenosis is lifted, they are often eager to eat, so patients should be instructed to gradually increase the amount of food and avoid swallowing hard, fiber-rich and sticky foods to prevent blocking the stent lumen. [3] We have encountered two cases of patients who swallowed snacks and large pieces of chicken to block the stent lumen after tube placement, and the lumen was restored to be smooth after endoscopic removal of the foreign objects. Avoid eating cold food to prevent the stent from becoming soft and dislocating. 3.3.2 Position After operation, elevate the head of the bed, so that the patient is in a semi-slope position to reduce reflux. And avoid large turning, bending and other positional changes. 3.3.3 Nursing care for preventing complications The complications of tube placement mainly include reflux esophagitis, fever, restenosis and absorptive pneumonia, the incidence of which was reported by Xu Guoming et al[2] to be 100%, 66.6%, 41.6% and 8.33% respectively. Postoperatively, changes in temperature, blood pressure, chest and abdominal signs, and the presence of black stools were observed. Mild postoperative chest and abdominal pain was caused by local irritation and reflux esophagitis, and the application of mucosal protectants and acid suppressants could reduce or relieve the symptoms. Antibiotics were routinely applied for 3 days after the operation in our hospital, and there was no case of fever or aspiration pneumonia. Memory alloy stent has good biocompatibility, and the foreign body sensation of patients after stent insertion is mostly due to psychological factors. 3 patients in this group had obvious foreign body sensation, which was not effective after explanation, and the patients were told that the stent had been taken out after endoscopic review, and the foreign body sensation disappeared soon. After endoscopic review, the patients were told that the stent had been removed and the foreign body sensation soon disappeared. Restenosis was mostly due to the re-obstruction of the stent lumen by cancerous tissues.