Stent Related Treatments
1) Endoscopic Treatments
Endoscopic Retrograde Cholangio-Pancreatography (ERCP)
An alternative to a stomach bypass operation is the insertion of a stent (a small metallic mesh tube), which holds the sides of the duodenum open in a similar fashion to a stent when it is inserted through a blockage in the bile duct. The aim of putting in a stent is to allow food and other substances to pass through the stomach and relieve your nausea and vomiting.
Where will I have a stent put in?
The procedure will be performed in a room in the X-ray department or endoscopy suite.
How long will it take?
The procedure will take approximately 30 minutes to perform.
Will this procedure work?
Stents can be placed successfully in about 95% of patients.
You must not eat or drink anything for several hours before the stent is inserted. (Your nurses will tell you when to stop eating and drinking.) If your vomiting has been severe, you may already have a naso-gastric tube in place, so that the staff can keep your stomach drained.
You will be taken in to the X-ray department or endoscopy suite in your bed, ready for you to be given your intravenous sedation. When you are feeling sleepy, the doctor will pass an endoscope down your throat and put the stent through the blockage using other specialised equipment. When it is all over, you will remain in the department until you are more awake and then return to the ward.
When can I get home?
You will be able to go home when you feel ready. Usually, this is within a few days of the procedure.
Are there any complications?
As with any operation, there is a slight risk of complications happening during or after the procedure. Complications linked with stent insertion include:
- Fluid getting into the lungs during the procedure
- Puncture of the digestive tract
- The stent moving; and
- The stent causing an unwanted opening in the digestive tract.
Eating and drinking after the insertion of a stent
Because the stent doesn’t move and is about three to four inches long there is a tendency for solid food to get stuck and consequently, rather than returning to a normal diet, you will be encouraged to take nourishing fluids and soft foods to prevent the stent becoming blocked with food particles. Your dietitian will advise you as to what the most appropriate foods for you.
2) Radiological Treatments
Percutaneous Transhepatic Cholangiogram (PTC)
PTC is a procedure to insert a stent performed under xray guidance. A needle is inserted through your skin just below your rib cage and a fine guide-wire is passed through your liver and into the blockage in the bile duct. The stent is then passed along this wire. Sometimes a small drainage tube is left in place until the position of the stent is confirmed.
What happens during a PTC?
You must not eat or drink anything for at least six hours beforehand. This may be done under sedation or occasionally under a general anaesthetic. You will also have a local anaesthetic, so you should not feel pain as the needle or wire is passed through the skin. Some people find that moving the wire into the correct position in the bile duct can be quite painful. To prevent any infection, a doctor will give you antibiotics before and after the procedure.
After your PTC you will need to lie flat in bed for six hours. It is likely you will stay in hospital for a few days afterwards until everything settles down.
Coeliac Plexus Block (CPB)
Occasionally drug related pain relief is not sufficient to relief symptoms and in this situation the nerves that arise in the pancreas can be blocked by injection of ethanol and local anaesthetic. This can either be performed using an endoscope (endoscopic ultrasound) or under xray guidance. Some patients can experience benefit from this approach.