The Eternal Enteral Stent

Abstract

Purpose: Background: Enteral stents are used for brief palliative management of pancreaticobiliary malignancies causing gastric outlet and duodenal obstruction. We report a case of a patient who presented 8 years after a duodenal ulcer perforation and stent placement. Case Description: A 92-year-old female presented with progressive nausea, vomiting and abdominal pain over 2 months. Past medical history was significant for a duodenal ulcer perforation and oversewing complicated by a draining enterocutanous fistula that was repaired with a stent 8 years ago. She had poor follow-up and never had the stent re-evaluated. On exam, she had mild abdominal distention and bilateral upper quadrant tenderness. An upper GI series showed an obstructive antral mass and CT showed a fractured stent and subserosal air. An EGD was performed and found the previously placed stent in 2 separate pieces with the ingrowth of inflammatory tissue. A new stent was placed bridging the fractured remnants. Discussion: Stents were first used for malignant gastric outlet obstruction in 1992. The primary indications for stenting are gastric, duodenal, and proximal jejunal malignant obstructions caused by nonresectable tumors. Other candidates include patients with previous surgical anastomosis who develop obstruction due to tumor recurrence and nonoperative benign gastroduodenal obstruction or stenosis. Stent placement is minimally invasive, allows for rapid gastric emptying, is cost-effective and enhances quality of life. Rare complications include wire ulceration, bleeding, perforation, migration, food impaction, and obstruction. Stent fracture was first described in 2002 and continues to be an uncommon complication. In one study of duodenal stents, 1.2% of patients had severe complications (perforation, bleeding), 5% had stent migration and 18% had stent obstruction, mainly due to tumor infiltration. The mean survival period of these patients was 12.1 weeks. In one study, duodenal stenting was successful in 96% of obstructed patients and the median duration of stent patency was 6 months (up to 15.7 months). Stent obstruction occurred in 14% of patients after a median time of 6.3 months (up to 15.7 months). Conclusion: This is the first case that reports a gastroduodenal stent that lasted for 8 years. In the literature, no stents were ever reported to be used for over 2 years and on average were patent for no longer than 6 months. Previously, stenting offered an effective palliative treatment option in patients with a short life expectancy. More recently, studies have shown that duodenal stents were effective over 1 year. Our case demonstrates that gastroduodenal stents could potentially have a lifespan of well over 2 years.