Duodenal stent

Using a duodenal stent to treat duodenal obstruction associated vomiting 

Some (10-20%) pancreatic cancer patients experience symptoms when their tumour begins to compress or restrict the duodenum (the first part of the small intestine, immediately after the stomach). This often occurs gradually and can present with a feeling of discomfort after eating and nausea. As the stomach has not emptied properly since the last meal, the patient often feels full after only a small amount of food (“early satiety”). Vomiting can relieve the discomfort, and fluids may be easier to tolerate than solids. The stomach can gradually stretch, leading to less temporal association with recent ingestion of food, but as food cannot reach the small intestine for nutrients to be absorbed, weight loss occurs. The stomach never empties properly, leading to a residue of stagnant, partially digested food and fluid. People may notice bad breath, and movement causes the stomach contents to move about, which can sound like water slopping in a hot water bottle (“Succussion splash”). 

One way to treat this is the use of a duodenal stent. This is a flexible tube made of an expanding metal mesh which, when inserted, helps to keep the duodenal walls apart, allowing soft foods and fluid to pass through it, relieving some of the symptoms.  

The procedure

The procedure takes place in an X-ray department or endoscopy suite and takes around 30 minutes. 

Your medical team will advise you when to stop eating and drinking before the stent is inserted. You will be given sedation through a cannula, and once you are sleepy, the doctor will pass the endoscope through your mouth, down your throat, and through your stomach to reach the blocked segment of the duodenum. A guidewire is then passed down the endoscope and through the blockage into the normal intestine, beyond which the stent is inserted. When confirmed to be in the right place, the stent is released, where it springs open to push apart the duodenal walls and relieve the blockage. 

The advantage of managing duodenal obstruction with a duodenal stent is that it does not usually require a general anaesthetic or surgical procedure and can be performed even in frail patients. It does have the disadvantage that as a rigid tube, the stomach and duodenal emptying are less efficient than in healthy, which is normally aided by intestinal contractions(peristalsis). Patients often require dietary modification to avoid difficult-to-digest solids and small frequent meals. The alternative is a surgical bypass of the blockage (a gastroenterostomy, joining the stomach to the small intestine beyond the blockage), which may be preferable in patients who remain fit and well, as the relief of symptoms can be more effective, but this requires general anaesthesia, and the risks can be slightly greater.