Self-expanding stents are designed to provide quick relief of enteric obstruction. The first attempts at stenting gastroduodenal obstructions were made in the early 1990s, using esophageal stents, sometimes through a gastrostomy, until the introduction of dedicated systems. The technique is based on the intuitive assumption that regaining enteral patency by a relatively noninvasive procedure is superior to other methods. A patient with only a few precious weeks to live should spend the shortest time possible undergoing palliative treatment that only relieves symptoms. Cost-benefit analyses have shown the effectiveness of the procedure. The first trials comparing stenting with open bypass surgery, as well as with the newer alternative of laparoscopic gastroenterostomy, are beginning to provide a scientific basis for the rationale of palliative stenting.
Nitinol stents in particular, will continue to expand gradually over several days and the temptation to carry out balloon dilation of a poorly expanded stent can be resisted. Stents can be seen to expand with air insufflation and peristalsis, indicating that the functional diameter is probably underestimated.
The technical success of the procedure exceeds 95%. Relief of symptoms is achieved in 80-90% within 2-3 days, and three out of four patients will manage at least a semi-solid diet.
The average life expectancy after duodenal stenting is 3 months.
Severe complications (perforation or bleeding) are rare (< 1%) and occur more frequently with poorly aligned stiff, sharp-ended stents, where they cause pressure erosion of the duodenal wall.