Pancreatic cancer often causes blockages within the digestive system. As the tumor grows, it can obstruct nearby structures, leading to various symptoms. Stents are commonly used to alleviate these obstructions and improve patient comfort.
Why Stents Are Used for Pancreatic Cancer
Pancreatic tumors frequently cause blockages by compressing adjacent organs. One common problem is bile duct obstruction, which carries bile from the liver to the small intestine. When blocked, bile builds up, causing jaundice (yellowing of the skin and eyes) and itching. A stent in the bile duct restores bile flow, relieving these symptoms and improving liver function.
Another frequent complication occurs when the tumor presses on the duodenum, the first part of the small intestine. This compression, known as gastric outlet obstruction, prevents food from passing through, leading to nausea, vomiting, and difficulty eating. A duodenal stent creates an open pathway for food, allowing patients to eat and maintain nutrition. In less common instances, the pancreatic duct may become blocked, though stents are less frequently used here compared to biliary or duodenal obstructions. Stent placement offers symptomatic relief and can serve as a preparatory step for other treatments, such as chemotherapy.
Understanding Stent Types and Placement
Stents for pancreatic cancer-related blockages are categorized by their target location: biliary stents for bile duct obstructions and duodenal stents for gastric outlet obstructions. Biliary stents open the bile duct, while duodenal stents create a passage through the compressed duodenum. The choice between plastic or metal stent materials depends on the anticipated duration of need and the patient’s treatment plan.
Plastic stents, made of polyethylene, are used for shorter-term relief, lasting three to six months. They are less expensive but have a smaller diameter, making them more prone to blockages and requiring more frequent replacement. Metal stents, made of nickel-titanium alloy, are self-expanding with a larger diameter, offering longer patency, often lasting six months to over a year. These are chosen for palliative care or when long-term relief is anticipated, as they are less likely to clog and require fewer re-interventions.
Stent insertion involves minimally invasive endoscopic procedures. Biliary stents are placed using Endoscopic Retrograde Cholangiopancreatography (ERCP). During ERCP, an endoscope (a thin, flexible tube with a camera) is guided through the mouth, esophagus, and stomach into the duodenum, to the bile duct opening. Contrast dye visualizes the blockage, and the stent is guided through the endoscope and deployed.
Duodenal stents are inserted via an upper endoscopy, where the endoscope is advanced to the obstructed duodenum, and the stent is positioned to open the passageway. In some complex cases, Endoscopic Ultrasound (EUS) guidance may be used for real-time imaging during placement, enhancing precision.
Life After Stent Insertion
Following stent insertion, patients experience immediate symptom relief, though minor discomfort (sore throat, mild abdominal pain) may occur for a day or two. This discomfort usually subsides as the body adjusts. The procedure’s primary goal is to improve quality of life by alleviating symptoms like jaundice, nausea, and vomiting, allowing for better nutritional intake.
Living with a stent involves considerations and monitoring. While specific dietary restrictions may not always be necessary, some patients find it beneficial to eat smaller, more frequent meals or modify their diet to softer foods, especially with duodenal stents. Activity levels generally return to normal as tolerated, though strenuous activities might be discouraged immediately after the procedure. Regular follow-up appointments with the healthcare team are important to monitor the stent’s function and address any concerns.
Patients should be aware of potential complications and know when to seek medical attention. Signs of stent blockage or migration include a return or worsening of original symptoms, such as jaundice, severe abdominal pain, or persistent nausea and vomiting. Fever and chills could indicate an infection, like cholangitis, requiring immediate medical evaluation. While complications can occur, they are often manageable with timely intervention, sometimes requiring stent replacement or adjustment.