What Are Enteral Stents?
If a patient has a blockage or obstruction, a stent is often used to keep the affected area of the body open. A stent is a hollow tube made of plastic or metal inserted into the area of the body that is affected. An enteral stent refers to a stent placement somewhere within the digestive tract—it could be placed in the esophagus, duodenum, or colon. Enteral stents are often used to open up an area where a cancerous tumor is growing to make the patient more comfortable or as part of preparation for surgery.
Who Receives Enteral Stents?
The majority of enteral stents placed are inserted because the patient has cancerous tumors that are causing a blockage or obstruction. In patients with diseases such as esophageal cancer, surgery may be the best option, particularly if the cancer is in its later stages. An enteral stent is placed as part of the preparation for the patient’s surgery.
An enteral stent may also be used to make the patient more comfortable. Depending on where the obstruction or blockage is, the patient may have trouble eating or discomfort, or both. A stent widens the area so that it’s easier for food to pass through.
A stent is also used to widen the digestive tract. It can also manage gastrointestinal problems, such as bleeding varices, fistulas, leaks, and perforation.
What Are the Different Types of Enteral Stents?
A stent is considered enteral if it is placed in the digestive tract. There are four main types of enteral stents: esophageal, duodenal and biliary, and colon stents.
- Esophageal stents. Esophageal stents are used for both benign and malignant conditions. This stent can help manage poor connection between the trachea and esophagus, narrowing of the digestive tract, which can be caused by anastomoses, peptic ulcers, or radiation. For malignant conditions such as esophageal cancer, stents can be used to manage cancerous tumors when the cancer is inoperable.
- Duodenal stents. The duodenum is the upper portion of the small intestine, and this area can be blocked by conditions related to pancreatic cancer. If the cancer is inoperable and is causing a blockage, a duodenal stent is used to allow the person to eat if the tumor is blocking the small intestine.
- Biliary stents. Pancreatic cancer can also affect the bile ducts, another necessary component for digestion. Tumors can put pressure on the bile ducts, causing a blockage. This obstruction often gives the patient jaundice (yellowing of the skin and eyes). Biliary stents are used as treatment for obstructive jaundice. They can also be used to manage benign conditions or as a pre-operative measure when surgery is possible for pancreatic cancer.
- Colon stents. If a patient has a blockage caused by colon or rectal cancer,, colon stents can be used to open up the blockage before surgery. This approach often leads to a better surgery outcome. If a patient with colorectal cancer isn’t a candidate for surgery, stents are used in the colon to widen the area where there is tumor growth. This procedure is often used on patients who have late-stage colorectal cancer in order to improve quality of life.
What Is the Preparation for Enteral Stents?
You will need to do some preparation before an enteral stent procedure. Your physician needs to know the exact location of the obstruction and how large it is, and they will measure the stricture from end to end. In order to determine location and size, your gastroenterologist may perform one of several diagnostic tests, including endoscopy, fluoroscopy, a computed tomography (CT) scan, barium enema, or radiography.
Your doctor will also discuss your current medication list with you. Depending on the drug, your physician may advise you to stop taking it leading up to the procedure. Also, you will receive sedation, so ensure you have someone to drive you home the day of the insertion.
If your enteral stent is due to a colon or bowel obstruction, you may have to take prophylactic antibiotics. This helps lessen the chances of infection after the procedure. Depending on the obstruction, you may or may not need to take a laxative prep to clear the bowel before the procedure.
What Happens During an Enteral Stent Procedure?
You will first be administered sedatives via an IV in your arm. An upper endoscope is used if an enteral stent is used to treat problems in the esophagus or upper part of the duodenum (small intestine). An upper endoscope is a long, thin tube inserted into the throat and can diagnose or treat conditions in the esophagus, stomach, and upper duodenum.
If the enteral stent placement is used to manage diseases of the colon, colonoscopy is used. Similar to endoscopy, a colonoscope is a long, thin tube inserted into the colon. It is often used for colon cancer screening, but it can also be used as therapeutic colonoscopy.
Your provider will use Through the Scope Placement (TTS Placement). Using the endoscope or colonoscope, your physician will locate the obstruction and insert a guidewire using the scope. The stent is then placed over the guidewire, ensuring that it perfectly matches the guidewire. Then, the stent is anchored in place using radial forces. The entire procedure takes about one hour.
After the procedure, you will be taken to a recovery room, where you’ll be monitored as the sedatives wear off. For several hours afterward, you are only allowed to consume clear liquids. If you had an esophageal stent placement, your doctor will talk with you about the dietary changes you must make. Those with an esophageal stent can only eat soft foods, such as oatmeal, scrambled eggs, and applesauce.
What Are the Risks with Enteral Stent Placement?
There are some risks associated with enteral stent placement. The most important thing during the procedure is that the stent is perfectly positioned, otherwise, stent migration (movement) can lead to perforation and tears. Possible risks of enteral stent placement include:
- Tracheal compression
- Stent migration
More serious potential complications of enteral stent placement include:
- Tumor ingrowth
Enteral stent placement overall is a safe procedure and can drastically improve a patient’s quality of life.