A duodenal stent is a small, flexible mesh tube placed into the duodenum, the first section of the small intestine connected directly to the stomach. This device keeps a narrowed or blocked passageway open, specifically addressing gastric outlet obstruction. This condition halts the normal flow of food and fluids from the stomach into the small intestine. By alleviating the blockage, the stent resolves symptoms like persistent vomiting, nausea, and the inability to eat normally, improving a patient’s ability to maintain nutrition.
Why Duodenal Stents Are Necessary
The need for a duodenal stent arises from an obstruction that prevents the stomach from emptying its contents into the small bowel. The most frequent cause is a malignant obstruction, often resulting from cancers of the pancreas, stomach, or duodenum, where the tumor mass or surrounding lymph nodes compress the intestinal wall. For many patients with advanced cancer, the stent offers a minimally invasive alternative to major abdominal surgery, such as a bypass, providing quicker symptom relief and a shorter recovery time. A less common indication is a benign stricture, which is a narrowing of the duodenum caused by scarring, chronic inflammation, or peptic ulcer disease. Stent placement is reserved for patients who are symptomatic and cannot tolerate a normal diet due to the blockage.
The Stent Placement Procedure
The procedure for placing a duodenal stent is typically performed endoscopically, often using a standard upper endoscopy or, less commonly, an Endoscopic Retrograde Cholangiopancreatography (ERCP) scope. The patient receives sedation for comfort during the process, which usually takes between 30 and 45 minutes. The doctor first passes an endoscope, a flexible tube with a camera, through the mouth, esophagus, and stomach to visualize the blockage in the duodenum. Once the narrowed segment is located, a fine guide wire is threaded through the stricture and past the blockage under X-ray guidance (fluoroscopy). The stent, usually a Self-Expanding Metal Stent (SEMS) made of wire mesh, is advanced over the guide wire to the precise location. The stent is constrained within a delivery system; once positioned, the outer sheath is removed, allowing the mesh tube to expand and press against the duodenal wall. Fluoroscopy confirms the accurate deployment, ensuring the stent fully bridges the narrowed segment and restores the open pathway.
Managing Life with a Duodenal Stent
Following the procedure, patients are monitored until the sedation wears off and can typically begin consuming thin fluids shortly after. The hospital stay is often short, with many patients discharged the next day, depending on their overall health. The most significant long-term adjustment involves dietary modification to prevent the stent from becoming blocked. A soft, moist, and low-fiber diet is recommended, especially in the initial period after placement. Patients should focus on foods like pureed soups, mashed potatoes, well-cooked vegetables, and soft proteins. Thorough chewing is important, as is eating smaller, more frequent meals instead of three large ones. Foods that are tough, stringy, or high in fiber must be avoided as they pose a risk of clogging the mesh, including:
- Raw vegetables.
- Nuts.
- Seeds.
- Tough meats.
Routine follow-up appointments and occasional imaging are necessary to monitor the stent’s function and position over time.
Recognizing and Addressing Common Stent Issues
While duodenal stents effectively restore digestion, they are susceptible to complications that require prompt attention. The most frequent issue is stent obstruction or clogging, which manifests with a return of the original symptoms, such as significant nausea and persistent vomiting. This blockage can be caused by food impaction or the overgrowth of tumor tissue into the mesh, known as tumor ingrowth, which tends to occur a few months after placement. Another potential issue is stent migration, where the device moves out of its intended position in the duodenum. This can lead to a recurrence of the obstruction. A less common but serious complication is perforation, a tear in the duodenal wall, indicated by a sudden onset of severe abdominal pain, fever, or signs of bleeding. It is imperative to contact a physician immediately if symptoms of blockage or severe pain return, as the issue may be resolved endoscopically through repositioning, cleaning, or placing a second stent. For patients with signs of perforation, emergency imaging like a CT scan is required to determine the severity and the need for immediate intervention.