Duodenal Stenting

Duodenal stenting is a medical procedure in which a small, expandable, metal mesh tube called a stent is placed in the blocked or narrowed area of your duodenum.

The duodenum is the first portion of the small intestine or small bowel, attached to the base of the stomach. The duodenal stent is placed across the blockage or narrowing and will expand to enable food and fluid to pass through from the stomach more easily. This will help to reduce symptoms such as regurgitation and vomiting.

Indications

Duodenal stenting is usually indicated for the treatment of gastric outlet obstruction as a result of pancreatic cancer.

After food is consumed, it passes from the stomach into the duodenum, where it gets further broken down or digested. If the duodenum is blocked, food cannot pass out of the stomach and accumulates in your stomach making you feel sick and nauseous. This is known as gastric outlet obstruction. Placement of a stent into the narrowed duodenum helps to hold the duodenum open so that food can pass through it. This alleviates your symptoms and enables you to consume food without any limitations.

Preparation

Preparation for duodenal stenting may involve the following steps:

• A thorough history and physical examination
• Routine blood work and imaging
• Informing your doctor of any medications or supplements you are taking or any conditions you have such as heart or lung disease
• Informing your doctor of any allergies to medications or anesthesia
• Refraining from medications such as blood thinners, aspirin, or NSAIDs, if indicated
• Refraining from solids or liquids at least 8 hours prior to the procedure
• Arranging for someone to drive you home after the procedure

Procedure

The duodenal stent placement procedure is performed using a standard endoscope with the assistance of fluoroscopy or live x-ray guidance. It typically involves the following steps:

• You will be asked to lie down in a supine or face-up position on the procedure table.
• Your physician will administer a sedative by injection to make you feel relaxed and sleepy throughout the procedure.
• An endoscope - a tube with a camera on the end - is passed through the mouth and  down into the duodenum. The scope is connected to an external monitor which displays the area of blockage or narrowing for your physician to view.
• Your physician will then pass a fine wire (guidewire) through the narrowing under x-ray guidance.
• Once the location of the guidewire is confirmed, the narrow stent delivery system is passed through the endoscope over the guidewire and across the stricture.
• The constraining sheath is removed, allowing the stent to expand, to enable food to pass out of the stomach.

Post-procedure care

Following the procedure, you will be transferred to the recovery room where you will be asleep until the sedation wears off. You may feel pain, soreness, or discomfort in the throat due to the scope. Medications are provided as needed to relieve your pain and discomfort.  You should be able to take liquids once your sedation wears off. A soft or pureed diet is recommended for the first few days so that the stent does not become obstructed. You should be able to resume your normal diet thereafter unless your physician instructs otherwise. You may require an overnight stay in the hospital depending upon how soon you recover.

Risks and Complications

Duodenal stent placement is a relatively safe procedure, however, as with any procedure, some risks and complications may occur, such as:

• Infection
• Bleeding
• Throat soreness
• Stent migration
• Stent blockages
• Duodenal perforation
• Tumor growth into the stent

Summary

Duodenal stenting is a medical procedure to place a stent in a narrowed or blocked area of the duodenum most often due to malignant cancer. The procedure helps to provide significant relief from obstruction-related symptoms such as regurgitation or vomiting to improve your overall quality of life.