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Thread: What to expect in post-op/recovery: duodenal stent

  1. #1
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    What to expect in post-op/recovery: duodenal stent

    Doug was taken off chemo some months ago and recently began to have pain, pressure, nausea and vomiting after eating. He is about to go in for placement of a duodenal stent to relieve an obstruction, likely caused by liver tumour growth compressing the area.

    Has anyone had one of these procedures done, and if so, what was the recovery like?

    Thanks, all!

  2. #2
    Super Moderator Top User sheila's Avatar
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    dont know anyone who has had a duodenal stent only ones dealing with the heart-that probably depends on if they are removing anything also or just adding the stent to keep it open. Also other factors would be is it an open surgury or laproscopic? Never heard anyone discussing this from what Ive read so far soory I cant help but I do pray its successful
    MOMS Journey
    April06- Emergencysurgery,exploratory,10units blood,largetumor and 10inches of colon removed,temp.colostomy.diagnosed stage IV colon.
    oxyplatin,5fu
    Oct06-radiation,surgery,several lymphs,cervix,1 ovary,fallopian,40% remaining colon,large tumor to adipose tissue,appendix,gallbladder removed.permant colostomy/iliostomy
    oxyplatin,transfusion.
    April 07-xeloda-overdose
    surgery-1/3liver,partial diaphra, removed clipped and questionable spots oblated.
    port-port rejection-port removed 1week.
    picc line,5fu,oxyplatin,camptosar.
    Oct-08-surgery-remaining ovary engulfed in tumor,partial bone scrape.
    transfusion central line TPN 1 month.
    oct-09-surgery tumor ,colon and jejuneum removed.
    xeloda reduced. severe dehydration,heart attack.
    april10-remission-avistan
    oct-10-erbitux,camptosar
    Jan-11-5fu
    mar-11 return to original site-oxyplatin,5fu
    Aug-11-erbitux,camptosar.
    dec-28-blood transfusion
    dec-30-back to chemo erbitux camtosar
    Jan-16 injections neulasta and aranesp
    feb16-transfusion
    feb 21-Tumor found stomach,liver, and liver "hot spots" inflamed lymph in rt ureter in kidney causing obstruction-surgery schedualed Mar 16.
    march 16/12-no more kidney obstruction not lymph ...dehydration is causing blockage, two litters blood for anemia, stomach liver tumor small-med,abalation, 1 hidden tumor deep in muscle mass on side flank(hid from scans) -gone!
    june/15/12-blood transfusion
    starting a regimine of celebrex
    aug/16/12-blood transfusion
    aug/30-12 discontinued celebrex -failure one kidney. needed to see urologist
    sept/10-12-good urologist report one kidney functioning well for now.
    oct/23/12-chemo pill Stivarga(regorafenib)
    Nov/22/12-blood transfusion
    dec/18/12-blood transfusion chemo pill dosage cut back to 1 pill.
    Feb/21/13 neulasta injection
    Feb/22/13-blood transfusion. still taking stivarga.
    mar/20/13-arenespt injection rehydration and magnesium IV
    mar/21/13-acute renal failure-kidney infection
    april/1/13.-recovery from 4 day coma infection cleared/4 units blood/ off stivarga/starting rehab therapy,
    swollen hand no apparent reason black spots in vision off and on. both cleared up.
    may/22/13-home oxycodone for pain shoulder neck arm
    june/1/13 pain subsided off oxy onto aleve
    june/09/13-pain back off aleve on vicodin
    june 10/13-cancer in back/neck- starting radiation for arm neck and shoulder pain.
    june24/13-last day of radiation-on steroids
    july1/13-swollen legs and feet-lasix off steroids still on vicodin and xanax
    july 23/13 vicodin cut in half blood transfusion.
    sept/6/13-off all pain meds since late aug
    scan results fracture in spine mid back
    sept/12/13-spine healing on its own,weaning off steroids, no visible tumors.
    nov/7/13-edema both legs and one arm on lasix since oct.
    nov/21/13- leg edema subsiding still alot in one arm- she is talking but keeps her eyes closed. achy but no major pain. nurse and aide to visit once a week schedualed. having trouble standing.
    nov/24/13-sadly but peacefully moms cancer journey is at an end, she will start her new spiritual journey together hand in hand with dad.

  3. #3
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    The sugery is palliative, done with an endoscope using x ray to support proper placement. Doug is so weak now I don't think he could weather a full scale surgery. The stent is placed and then expanded, which should relieve his symptoms and allow at least a soft diet going forward. I can find lots of info on the stent procedure online, NO information on recovery, and physical effects of having a metal mesh stent in your small intestine.

  4. #4
    Senior User swisecar's Avatar
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    Will you be meeting with the doctor performing the procedure? I am sure he/she could answer your questions.

    IN GENERAL, endoscopic procedures are well tolerated. A news release from Boston Scientific at the May 2010 digestive health week stated that, "endoscopic duodenal stenting is associated with lower costs and shorter hospital stays than surgical gastrojejunostomy (GJ) for the relief of malignant gastric outlet obstruction."

    Here is an excerpt from the release:

    "An analysis of the Medicare database was conducted to identify hospitalizations for endoscopic
    stenting and surgical GJ for malignant gastric outlet obstruction between 2006 and 2008. The database
    included 423 endoscopic stenting and 352 surgical GJ hospitalizations that met the study inclusion
    criteria. Results showed that the median cost per hospitalization ($15,279 vs. $27,790, p<0.0001)
    and the median length of hospital stay (LOS) (8 vs. 16 days, p<0.0001) were significantly less for
    endoscopic stenting than surgical GJ."

    "The study also evaluated clinical outcomes for 29 patients who underwent endoscopic stenting and
    75 patients who underwent surgical GJ at the University of Alabama at Birmingham Hospital, and
    compared rates of technical and treatment success, post-procedure LOS and delayed complications.
    While both treatment methods were technically successful and relieved malignant gastric outlet
    obstruction, the median post-procedure LOS was significantly shorter for endoscopic stenting than
    surgical GJ (1.5 vs. 10.7 days, p<0.0001). There was no difference in rates of delayed complications."

    Given the obstruction presence of an obstruction, the placement of the stent is necessary. The endoscopic procedure would be preferred over the surgical method. Without treatment, the small bowel could rupture. Even without rupture, proper nutrition intake would be impossible with an obstructed small bowel, not to mention extremely painful. I also found the following information which may be helpful.

    The following is Google's cache of http://www.pancreaticcancerscotland.....asp?Content=8. It is a snapshot of the page as it appeared on Nov 25, 2010 07:09:15 GMT. The current page could have changed in the meantime.

    DUODENAL STENT INSERTION

    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 to do?
    The procedure will take approximately 30 minutes to perform.

    Will this procedure work?
    Stents can be placed successfully in about 94% of patients.

    What happens?
    You must not eat or drink anything for several hours before the stent is inserted (the 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 we can keep your stomach drained.

    You will be taken to the X-ray department or endoscopy suite, in your bed ready for you to have your intravenous sedation. When you are feeling sleepy, the doctor will pass an endoscope 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?
    Like 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.
    Bleeding.
    Puncture of the digestive tract.
    The stent moving.
    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 3 to 4 inches long there is a tendency for solid food to get stuck, and consequently rather than returning to a normal diet your will be encouraged to take nourishing fluids and soft foods to take to prevent the stent becoming blocked with food particles. Your dietitian will advise you what are the most appropriate foods to eat.
    May 1988 acute lymphoblastic leukemia (2 yrs chemo & radiation)
    Sept 2009 papillary thyroid cancer (thyroid removal & radioactive iodine)
    Sept 2009 colon cancer stage IIIC (removal of sigmoid colon & resection)
    Oct 2009-May 2010 FOLFOX6
    July 2010 stage IV colon cancer, irinotecan & avastin
    Dec 2010-July 2011 avastin maintenance
    Sept 2011 tumor removal involving small bowel resections
    Nov 2011-April 2012 resume irinotecan
    May 29 2012 begin radiation treatments 15 total
    current age: 28

  5. #5
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    Thankyou for that post...I had found most of this on the web.

    As for meeting with the doctor, we are in a difficult position. Doug has always been an angry and uncooperative sort of person. He has brought this attitude to his experience of cancer, and while I am unclear whether he doesn't ask questions of his medical team, or whether he just doesn't understand or listen to or pass on the answers, we get little information on the why and wherefore of his treatment options. Doug is fixated on one outcome: cure. He will not talk about the fact that, barring a miracle, he will die, likely very soon, from complications of his long standing Stage IV diagnosis. So there is also no way to discuss how to make the time he does have left meaningful, how to plan his best outcome possible, the role of hospice or end of life counseling, and what Doug can do to help those he is leaving behind.

    A friend recently lost a dear friend of her own and in that person's obituary was this sentence, which moved me deeply:
    Jack used his cancer diagnosis eight months ago as an opportunity to examine the question of what lives on and what passes away.

    I wish Doug could use that idea as a framework for his own experience, but that is very unlikely now. So we are left with no direct conduit to the physician/s, who is/are rarely available anyway.

    Doug had his stent placed yesterday and is experiencing a lot of pain and diarrhea. I have no idea whether this is normal, or perhaps due to meds, etc. It is a frustrating and upsetting experience for me, let alone Doug. I hope some kind oncology doctor or nurse reading this would begin a web site on treatment options AND post treatment option experiences and strategies. I can read all about the research as to why stent placement is a good thing, but there is nothing out there on life after the stent, aside from median survival stats, which are pretty grim.

    This adds to my sense that since Doug moved into the palliative range of care, he has dropped way down on the list of priorities in the medical system. When he presents at emerg, nobody gets very excited...I think because after one look at his chart, they wonder "why bother, what are we saving this guy for, more suffering?' I get that, but it's not good enough. And since he is refusing to look at hospice ideas or sit with hospice workers, we are in a kind of limbo.

    Anyway, another set of rarely talked about aspects of this condition; how to live with an uncommunicative, scared and angry person with a terminal condition, how the communication does not flow down to the family (particularly when there is no spouse to step in and attend appointments), and how terminal patients do not always either ask for or have access to, good palliative support.

  6. #6
    Top User DulcimerGal's Avatar
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    Prairie,

    Your post is just so sad, and I have no answers for you. Just one comment, REB posted a while back also about leaving a legacy behind - he referenced his children and his paintings...reminds me of what your friend's obituary said. How sad for Doug that he is internalizing/denying his experience. I wish we could help in some way, as he needs to know his life had value. I think that is the hardest part to come to terms with.

    Since I had cancer and am now surviving, I try to make sure I am working on both my legacy and knowing that I add value to others.

    You make such good points about our medical world and realities, would that someone on here has some great advice for you as I feel woefully inadequate. It is my biggest fear that if I ever get to stage four - that I will be brushed off like that too.

    Sending prayers of support
    DulcimerGal
    Rectal Cancer diagnosed Valentines Day 2008 - stage 3
    Finished 6 weeks of radiation and chemo 4/23/08
    Surgery to remove tumor - June 18th 2008
    Colostomy Reversal August 20th 2008
    Chemotherapy 5 months (Xeloda) finished Christmas 2008
    Local recurrence found May 2011
    Permanent colostomy and salvage APR surgery June 3rd 2011
    Stage 3C - 4 of 12 lymph nodes involved
    Finished 12 treatments of FOLFOX 6 - January 17th 2012 - Happy Dance!
    March 2012 - clean CAT Scan
    August 2012 - Cancer moves to stage 4
    CAT shows cancer cells implanted in pelvis/abdomen
    September - PET shows lung lesion 1.4 x 1 cm
    October - begin sessions of Folfiri.3 - Avastin, Irotecan, 5fu
    February 2013 - tumors shrinking, continuing biweekly chemo
    April 2013 finished all 12 Folfiri treatments, scan shows only lung lesions
    May - October Blessed chemo break!
    October 2013, scan shows more growth in pelvis and lungs
    Continue with biweekly Folfiri.3 - Avastin, Irotecan, leucovorin, 5fu
    April 2014 CAT scan shows tumors in liver
    June 2014 More tumor growth, stop Irinotecan cocktail after two years
    June 2014 Begin Regorafenib (Stivarga)

  7. #7
    Senior User swisecar's Avatar
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    I think the poor survival time is due to fact that the procedure itself is pallitative care for late stage cancer patients.

    I am a stage IV patient and my experience overall has been good. However, I did go to get a second opinion at Vanderbilt, and I was told by the doctor I saw there to get my affairs in order. He also said that it was my choice whether or not to do further chemotherapy, but that it probably wouldn't make any difference. That was in July, and as of October, both of my tumors have been reduced in size by 50%. I have had my care here in Knoxville. The oncologist is good at treating the cancer, but not necessarily the person. I have met with a psychologist and go to group activities at our local Cancer Wellness Center.

    I never go to any appointments alone. I know that many are not in the position to attend the appointments of their loved ones. I too have been told that we are not working for a cure, but rather control. I still have to hope. I sense anger and frustration on your part too. If Doug chooses not to work through the issues, then that is his decision. That does not mean that you can't work through your own issues with your situation. Also, maybe he doesn't share all the information because he's trying to protect you and the rest of your family. In many ways I think that caregivers have it just as bad as the patients. So please take care or yourself too.
    Last edited by swisecar; 11-30-2010 at 04:23 AM.
    May 1988 acute lymphoblastic leukemia (2 yrs chemo & radiation)
    Sept 2009 papillary thyroid cancer (thyroid removal & radioactive iodine)
    Sept 2009 colon cancer stage IIIC (removal of sigmoid colon & resection)
    Oct 2009-May 2010 FOLFOX6
    July 2010 stage IV colon cancer, irinotecan & avastin
    Dec 2010-July 2011 avastin maintenance
    Sept 2011 tumor removal involving small bowel resections
    Nov 2011-April 2012 resume irinotecan
    May 29 2012 begin radiation treatments 15 total
    current age: 28

 
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