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Stent-In-Stent for Tumour Ingrowth — SCE Palliative Medicine MCQ

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HardNausea & VomitingStent-In-Stent for Tumour IngrowthSCE Palliative Medicine

A frail patient with pancreatic cancer develops recurrent vomiting six weeks after successful duodenal self-expanding metal-stent placement. CT shows tumour ingrowth through the stent with no distal obstruction. What is the most appropriate palliative intervention?

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Correct answer: A — Deploy a second enteral stent within the obstructed stent

Recurrent malignant gastric-outlet obstruction from tumour ingrowth can often be treated by placing a second enteral stent through the first. Removal of an embedded uncovered stent risks perforation and bleeding. A prokinetic does not overcome fixed mechanical obstruction, and major resection is rarely proportionate in a frail patient needing rapid palliation.

Reference: ESGE guideline: endoscopic management of malignant gastric outlet obstruction: https://pubmed.ncbi.nlm.nih.gov/33105568/; NICE NG85: Pancreatic cancer in adults: https://www.nice.org.uk/guidance/ng85/chapter/Recommendations