What is a Gastrointestinal Stent?
A gastrointestinal stent is a small flexible metallic or plastic mesh tube that is placed in specific regions in your digestive tract such as the esophagus, stomach, or intestine(bowel) to relieve a blockage and open up the passage. It is usually recommended for the treatment of partial or complete obstruction caused due to gastrointestinal cancers both in the early stage and also in the late stage (high risk patients).
What are the Complications of Gastrointestinal Cancer?
People with gastrointestinal cancer suffer from the following complaints:
- Impaired bowel function
- Dysphagia: difficulty in swallowing
- Impaired quality of life
What are the Indications for a Gastrointestinal Stent?
A gastrointestinal stent is recommended for the treatment of gastrointestinal obstruction caused due to any of the following:
- Gastrointestinal lesions which may become cancerous
- Esophageal adenocarcinoma: cancer of the esophagus (food pipe)
- Gastric (stomach) cancer
- Duodenal cancer
- Pancreatic cancer
- Colorectal cancer
- Biliary/bile duct obstruction
In the recent times, gastrointestinal stents have also been employed for the treatment of postoperative leakage and to control gastrointestinal bleeding.
What are the Different Types of Gastrointestinal Stents?
Gastrointestinal stents can be classified based on the area for which they are used. These include:
- Esophageal stents: for the treatment of esophageal obstruction, bleeding, or leakage
- Biliary stents: for the treatment of biliary obstruction
- Gastroduodenal stents: for the treatment of duodenal obstruction
- Colonic stents: for the treatment of colonic obstruction
Gastrointestinal stents can be categorized based on the material the stent is made of. It is basically classified into the following two types:
- Self-expandable metal stent (SEMS): made of metal, i.e. stainless steel and alloys such as nitinol
- Self-expanding plastic stents (SEPS): made of plastic or silicone
They could also be fully covered, partially covered, or uncovered depending on the covering over the cylindrical mesh.
- Fully covered stents: They are covered with a synthetic material over the metal mesh.
Advantages: Relatively low risk of tumor ingrowth and easy to remove
Disadvantage: They have a higher chance of migration
- Partially covered metal stents: They are covered with a synthetic material over the metal mesh with small pieces of bare metal at the ends to minimize the risk for migration.
- Uncovered metal stents: They do not have a covering over the mesh.
Advantages: Less likely to migrate
Disadvantage: Higher chances of tumor ingrowth and are more difficult to remove
Pre-Surgical Preparation for a Gastrointestinal Stent
Presurgical preparation for gastrointestinal stenting begins with a thorough examination by your gastroenterologist to check for any medical issues prior to stenting.
- You may be required to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
- You may be instructed to follow certain dietary restrictions and lifestyle changes to ensure successful stent placement.
- You may be required to avoid food and drink for few hours before the procedure.
Gastrointestinal Stenting Procedure
For gastrointestinal stenting, first you are required to change into a surgical gown or drape.
- You will be placed on the operating table.
- The choice of anesthesia: general or local lies with your doctor.
- Depending on your age, medical condition, and the site of blockage, the endoscope may be introduced either through the mouth or the rectum.
- It is advanced to the blockage site under X-ray or fluoroscopic guidance to place a guide wire across the blockage.
- Then, your surgeon advances the stent over the guide wire and places it at the site of blockage.
- There is an introducer system especially for the expandable stents, in which the stent is compressed against a guiding catheter using an outer catheter sheath. This helps secure the stent at the blockage site.
- After the stent has been placed properly, the guide wire and endoscope are removed.
- Over the next few days, the stent expands further and helps clear the blockage.
Care and Recovery after Gastrointestinal Stenting
You are allowed to go home after gastrointestinal stenting. Your doctor will give you specific instructions related to diet and lifestyle. You may also be prescribed medications to keep you comfortable and help in a smooth recovery. You can return to your regular activities soon after the stent procedure.
What are the Risks and Complications of a Gastrointestinal Stent?
Gastrointestinal stenting is relatively safe. However, it may have certain risks and complications such as:
- Stent migration: stent may move to another part of the body