Stomach stent placement

If you have a tumor blocking food and drink in your upper gastrointestinal (GI) tract—at either end of your stomach, or in your esophagus or the beginning of the small intestine—your doctor may suggest putting in a stent.

Why it’s done

Blockages can prevent you from eating and drinking normally, and they may cause vomiting, pain, dehydration and weight loss. If malignant cancer is causing the blockage, you may not be in good enough health to undergo surgery to remove it, or the cancer may have spread too widely to remove it all.

Placing a stent in the blocked area is less risky and less invasive than surgery. The purpose then isn’t to treat the cancer, but to improve the quality and remaining length of life. This is called palliative treatment. Many patients are helped by this procedure.

Types of stents and how they’re placed

An endoscope is used to place a stent. This thin device can be put down your throat until it reaches the blockage. The surgeon guides the endoscope by watching its progress using fluoroscopy, a type of X-ray imaging. Once at the blockage, the stent can be sent down and put in position to prop open the area. In the case of some esophageal blockages, the tumor prevents the endoscope from being passed through. Dilation of the area is first done with a balloon, and then a stent is passed down the esophagus along a guide wire.

For blockages in the upper, or proximal, part of the stomach, stents are placed where this organ connects to your esophagus. Tumors in the lower, or distal, part of the stomach can block its connection to the small intestine. This condition is termed malignant gastric outlet obstruction, or MGOO. It’s often seen in people with cancer of the stomach, duodenum (first part of the small intestine), pancreas, gallbladder and bile ducts.

Stents are often made of metal and may be covered (coated with another substance) or uncovered. Uncovered stents have a lower rate of shifting out of position and are more flexible, making placement easier. Covered stents have fewer problems with tumors growing into their mesh or enveloping them. Many of the stents used nowadays are called self-expanding metal stents (SEMS). Once placed, these SEMS take a couple of days to fully expand.

Metal stents resemble a mesh tube of wire, and placement is easier and less likely to cause trauma than with older, rigid plastic stents. Newer plastic stents are self-expanding. Esophageal stents are often placed midway down the tube that connects your mouth to your stomach. They can be positioned at the end toward the stomach, but that location can increase the chances of regurgitation and gastric reflux. Stents with an anti-reflux valve have been developed to counter this problem.

Because esophageal cancer often isn’t recognized until it’s in an advanced stage, removal of tumors may not be possible, so stenting can help keep the esophagus open so you can eat and drink. Removable self-expanding silicone stents have been used for patients on chemotherapy to shrink a tumor before surgery. This avoids surgery to implant a feeding tube.

What to expect before and after the procedure

For eight or more hours before your procedure, you will not be allowed to eat or drink. An intravenous (IV) line will be inserted into a vein. To make you comfortable, you will be given either a sedative or general anesthesia. The entire procedure may take less than an hour.

Once the stent has been placed, you’ll have to wait for the effects of the anesthesia to wear off. You’ll likely need to arrange for transportation to and from the hospital, as you may still be groggy from medication. In some cases, your doctor may choose to have you stay overnight at the hospital.

You’ll be placed on a soft-food diet with these precautions:

• Chew food well
• Sit up while eating
• Eat more often with smaller portions
• Don’t rush through meals

Foods to avoid include:

• Bread
• Whole-grain pasta and rice
• Fibrous fruit and vegetables (this includes salads, raw veggies and dried fruit)
• Nuts
• Tough pieces of meat

Foods your doctor or dietitian may approve include:

• Poached fish
• Finely chopped meat
• Eggs
• Soup
• Mashed potatoes
• Well-cooked vegetables and stewed fruit
• Yogurt and ice cream

Tell your doctor if you think food has gotten stuck, causing you to feel full or sick and not be able to eat and drink normally. Drinking warm or carbonated liquids may help clear the stuck food.

Benefits and results

If you have gastric outlet obstruction caused by tumors, placement of a stent to permit passage for food and drink can help restore some of your quality of life.

Gastric obstructions cause nausea, vomiting and cachexia, a wasting condition in which the body breaks down muscle and fat tissue, resulting in severe weight loss and weakness. Cachexia typically occurs in people with advanced cancer, most commonly with pancreatic and gastric cancers. MGOO also increases the risk of aspiration pneumonia, which occurs when you inhale food or drink.

Complications and risks

• A stent can move out of position, in which case your surgeon may remove and replace it. If it’s not causing symptoms, the stent may be left in, and a second one is put in place. As many as 23 percent of covered stents in the esophagus may move out of place, or migrate, according to a 2011 review in International Scholarly Research Notices, and migration of uncovered esophageal stents occurs about 8.7 percent of the time. For all types of stents placed in the upper gastrointestinal tract (from the esophagus through the duodenum), migration ranged from 10 percent to 25 percent for covered stents and 2 percent to 6 percent for uncovered stents, according to a 2012 review in Clinical Endoscopy.
• There’s a small chance of perforating the intestinal or esophageal wall. Chest pain is the most common problem following esophageal stent placement.
• The tumor may grow into or over the stent. This may be dealt with by laser, photodynamic therapy or placement of a second stent. The rate of obstruction cases, by tumor growth or because of food stuck in upper gastrointestinal stents, has been estimated at 3 percent to 15 percent with covered stents and 10 percent to 42 percent with uncovered stents, according to the Clinical Endoscopy review.
• Minor bleeding a day or two after placement is common. This may cause a metallic taste in your mouth.
• Heartburn, gastric reflux or, in the case of esophageal stents, aspiration of food or liquid is possible. Tell your doctor if you experience any of these. Inhaling food or liquid can result in aspiration pneumonia.