Find out about how stents can relieve symptoms caused by advanced pancreatic cancer.
Ways of relieving jaundice
Pancreatic cancer can sometimes cause pressure on the bile duct and block it.
This causes jaundice, which can cause:
- yellowing or darkening of the skin and whites of your eyes
- feeling sick
- loss of appetite
- darkened urine
- pale coloured stools (poo)
- lethargy and tiredness
Your doctor might suggest putting a small flexible plastic or metal tube (stent) into the bile duct. It allows the bile to flow into the bowel and reduces the symptoms of jaundice.
Having a stent put in is generally a simple procedure. It is often done during an ERCP (endoscopic retrograde cholangio pancreatography).
If the stent does not work, your specialist may suggest bypass surgery to relieve jaundice. This is quite a major operation. You might want to talk this over fully with your doctor and nurse as well as with your close family and friends. No one can say how much you will benefit from the operation.
You may make a good recovery and feel better for longer if you do have the surgery.
Having a stent for a blocked bile duct
For either of these procedures, your doctor will ask you not to eat or drink for about six hours beforehand so that your stomach and upper bowel are empty. You have sedation for the procedure to help relax you.
Your doctor puts a flexible tube called an endoscope into your mouth and passes it down your throat to your stomach. The endoscope has a light and camera attached, and the doctor can watch the images of the inside of your body on a screen.
The endoscope tube is passed through your stomach to your duodenum (the first part of the small bowel). Your bile duct opens into the duodenum.
The doctor then injects dye into the bile duct and uses an x-ray to watch the flow of the dye to see where the duct is blocked. Once the blockage is found, the duct is stretched and the stent put in place.
This is called percutaneous transhepatic cholangiography (PTC). You have a local anaesthetic to numb the area where the needle goes in. Dye is used to show up the bile duct and blockage.
Your doctor puts a needle attached to a wire through the skin and moves it carefully into position inside the bile duct. An x-ray helps the doctor to see where to put the wire.
Once the wire is in place, the doctor feeds the stent along the wire until it is in place inside the bile duct. The wire is then removed.
After a stent procedure
You need to recover from the sedative. Your doctor might want you to stay in hospital overnight while you recover.
There are not many side effects from having a stent put into the bile duct. You might need to take antibiotics for a few days afterwards to prevent infection. You are at risk of an infection because bacteria from your gut can travel up the stent to the bile duct.
You should contact your doctor straight away if you have any signs of an infection, such as a high temperature and shivering.
A stent should keep the bile duct open and stop bile building up and causing jaundice. You should notice the benefit within a day or two of having your stent put in.
Stents can become blocked after a few months. If necessary, your stent can be replaced by the same method.
Relieving a blocked bowel
Pancreatic cancer can block the top of the small bowel (duodenum). You'll probably feel and be sick as the blockage stops food and drink passing from the stomach into the bowel.
One way of relieving this is to have a stent put in to keep the duodenum open. This should give give you relief from being sick, and so you might feel like eating again.
Your doctor may put a stent into the bile duct at the same time as the duodenum.
If you are unable to have a duodenal stent, your doctor may offer you surgery to bypass the blockage.
Your doctor might also suggest a drug called somatostatin or octreotide. It works by reducing the amount of fluid that builds up in your stomach and digestive system. This helps to stop you being sick and can relieve bloating.
About the procedure
A stent usually goes into the top part of the small bowel (duodenum) using endoscopy. You will not be allowed to eat or drink for about six hours before the procedure.
After sedation to help relax you, the doctor puts the endoscope into your mouth. It passes through your food pipe and stomach into the duodenum. A thin guide wire is then passed down the endoscope into the area of the blockage.
The endoscope is the removed and a stent is passed down the guide wire. The stent begins to gradually expand and opens up the blockage.
Once you have recovered from the sedation your nurse will give you a drink. It takes about 24 hours for the sedation to leave your system so you may feel drowsy during this time.
This is normally a safe procedure. Sometimes there is a little bleeding during the procedure, but this normally stops by itself.
Any pain normally settles within a day or two. Your nurse will give you painkillers to help.
The stent may slip out of position, but this is rare. If this happens, or the stent becomes blocked, you may have another stent put in.