Gastrointestinal and Bilio-Pancreatic Stenting

Introduction

Stenting is a minimally invasive procedure done to open up vessels or tracts that are narrowed due to various reasons. Stents are frequently used to treat constricted coronary arteries, which supply the heart with blood that is rich in oxygen. Stents are also occasionally used to treat lung narrowing and aneurysms. Aneurysms are bulges in the weakened area of an artery wall. Stents can be metal mesh, fabric, silicone, or a combination of materials. Fabric stents (stent grafts) are usually used in larger blood vessels like the aorta. Silicone is the common material of choice for stents used in the lungs.

What Is a Gastrointestinal Stent?

A gastrointestinal stent is a tiny flexible mesh tube made of plastic or metal inserted into some parts of the digestive tract, like the stomach, intestine, or esophagus. This is done to clear obstructions and widen the passage. It is typically advised to treat both early and late-stage (high-risk patients) partial or total blockage brought on by gastrointestinal malignancies or other conditions.

What Are the Indications of a Gastrointestinal Stent?

A gastrointestinal stent is used when an obstruction occurs in the gastrointestinal tract. An obstruction in the gastrointestinal tract can occur due to:

• Malignant lesions in the gastrointestinal tract.

• Esophageal adenocarcinoma (cancer of the esophagus).

• Cancer in the stomach.

• Duodenal cancer.

• Pancreatic cancer.

• Colorectal cancer.

• Obstructions in the bile duct.

What Is Bilio Pancreatic Stent?

Biliary and pancreatic stents are usually plastic or metal. They are used to check if the pancreatic or bile duct is open. They can also treat pancreatic fluid accumulation biliary or biliary leaks and avoid pancreatitis following endoscopic retrograde cholangiopancreatography (an endoscopic retrograde cholangiopancreatography combines endoscopy and fluoroscopy to diagnose and treat the problems of the biliary or pancreatic ductal systems).

What Are the Indications of Bilio Pancreatic Stent?

Bioio-pancreatic stents are used in the obstructions in the bile duct or the pancreatic ducts. A biliopancreatic stent can be used in the following conditions:

• Benign biliary strictures (narrowing of the bile duct due to various reasons like a post-operative injury, chronic pancreatitis, radiation therapy, etc).

• Biliary stones.

• Leaks in the bile duct usually can be due to a trauma or surgical procedure done previously.

• Cholecystitis (an inflammation of the gall bladder).

• Bleeding from the bile duct or the pancreatic duct following a surgical procedure or trauma.

• Perforations in the bile duct or the pancreatic duct.

• Distal malignant biliary obstruction (It occurs due to malignant tumors in the pancreas, biliary tract, gall bladder, metastasis from the lymph nodes, etc.).

• Hilar malignant biliary obstruction (HMBO is a complex condition and might require endoscopic drainage. It can occur due to cancer in the liver, extending to the gall bladder and other parts).

What Are the Types of Gastrointestinal Stent?

1. Based on the area of use, gastrointestinal stents can be of different types. They can include:

• Esophageal Stent: This is used in managing bleeding, obstruction, or a leak in the esophagus.

• Biliary Stents: These are used in managing obstruction in the bile duct.

• Gastroduodenal Stent: It is used for obstruction in the duodenum.

• Colonic Stents: They are used in the management of colonic obstructions.

2. Based on the type of material used in the manufacture of the stent, it is of two types:

• Self-expandable Metal Stents: They are usually made of stainless steel alloys like nitinol.

• Self-expanding Plastic Stents: They are usually made of plastic or silicone.

3. Depending on the covering of the cylindrical mesh, gastrointestinal stents are divided into:

• Fully Covered Stents: They are covered with a synthetic material above the metal. These are easy to remove and have lesser chances of tumor ingrowth.

• Partially Covered Stents: They have small areas not covered with synthetic material over the metal. This reduces the risk of migration of the stent.

• Uncovered Stents: These stents lack a covering over the metal material and are less likely to migrate. However, they have an increased chance of tumor ingrowth and are difficult to remove.

How Is a Gastrointestinal Stent Inserted?

Single plastic stents and Self-Expanding Metal Stents (SEMS) can be inserted without biliary sphincterotomy (cutting the biliary sphincter); however, blended electrosurgical current must be used if indicated. The external diameter of biliary stents is measured in French (Fr), which is equivalent to one-third of a millimeter. Most conventional duodenoscopes feature 4.2 mm diameter working channels, which prevent the introduction of larger plastic stents. The distance between the stent's proximal and distal flaps is typically known as the stent length.

What Are the Complications of Gastrointestinal Stent?

The risks and complications of placing a gastrointestinal stent can include:

• The gastrointestinal stent can be misplaced with time. Hence, it might require the surgeon to replace it normally. If there are no symptoms that cause disturbance to the patient, another stent can be placed in place. According to a 2011 review published in International Scholarly Research Notices, up to 23 percent of covered stents in the esophagus may migrate or move out of place, and about eight percent of uncovered esophageal stents migrate. Ten to twenty percent of covered stents placed in the upper gastrointestinal tract may have migration.

• There is a slight possibility of esophageal or intestinal wall perforation. Chest pain is the most typical issue after the implantation of an esophageal stent.

• The tumor might spread across or into the stent. A second stent could be inserted, photodynamic therapy could be used, or a laser could be used. It has been estimated that the rate of obstruction cases resulting from tumor growth or food stuck in upper gastrointestinal stents is three to fifteen percent for covered stents.

• Minor bleeding following stent placement is considered normal.

• There can be a mild change of taste in the mouth due to the bleeding. At times, a metallic taste can be felt.

• It is possible to aspirate food or liquids if you have esophageal stents or experience heartburn or gastric reflux.

Conclusion

Gastrointestinal stents are lifesavers when it comes to an obstruction in the gastrointestinal area. It opens up the narrow space and allows free passage of substances. Gastric obstruction can make the life of the patient miserable. In addition to causing nausea and vomiting, gastric blockages can also lead to cachexia. This wasting disease causes the body to break down muscle and fat tissue, causing severe weight loss and weakness.