Enteral Stents in the Gastric Outlet and Duodenum

 

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Objectives

Self-expanding stents are designed to provide quick relief of enteric obstruction. The first attempts at stenting gastroduodenal obstructions were made in the early 1990 s, using esophageal stents, sometimes through a gastrostomy [1] [2], until the introduction of dedicated systems. The technique is based on the intuitive assumption that regaining enteral patency by a relatively noninvasive procedure is superior to other methods. Alternatives consist of bypass surgery or continuous external drainage. Many patients are unfit for gastroenterostomy, and drainage via nasogastric tube or venting gastrostomy does little to improve a patient’s already poor quality of life. The effects extend beyond vomiting, dehydration and inadequate calorie intake: nausea and regurgitation of foul stomach content are a constant reminder of the underlying cancer, and patients are excluded from social interactions associated with eating and drinking.

A patient with only a few precious weeks to live should spend the shortest time possible undergoing palliative treatment that only relieves symptoms (Latin palliare, to mask, to cloak). Cost-benefit analyses have shown the effectiveness of the procedure [3] [4]. The first trials comparing stenting with open bypass surgery, as well as with the newer alternative of laparoscopic gastroenterostomy, are beginning to provide a scientific basis for the rationale of palliative stenting [5] [6].

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H.-U. Laasch, Dr. med., MRCP, FRCR

Dept. of Clinical Radiology, Central Manchester University Hospitals

Oxford Road · Manchester M13 9WL · United Kingdom

Fax: + 44-161-2768916 ·

Email: hu_laasch@doctors.net.uk