Does anyone have any experience of how well anti-reflux stents work?

[Swaz]

My husband had chemotherapy and an oesophagogastrectomy for oesophageal cancer in September 2012 and was well until last August when we were told the cancer had returned in lymph nodes. He had 16 weeks of palliative EOX chemo which ended when he became ill with pneumonia this January and bad reflux. He has had 2 more bouts of (? aspiration) pneumonia and has currently been in hospital for 4 1/2 weeks. He has been offered an anti-reflux stent to stop the stomach acid and bile refluxing (which is very bad) but is very apprehensive about such a step. He currently has an NJ feeding tube and an NG tube to aspirate the bile etc. Has anyone got any advice about such stents?

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This is one for you to discuss with the medical team who will have practical experience of how they work, which I do not have, so do not be too influenced by what I suggest. I know this might sound as though I am stating the obvious, but you do need to talk things through with the medical team so that your expectations are realistic.

A stent is usually inserted to maintain a passageway through the oesophagus to allow food and drink to pass through into the stomach where it would otherwise be blocked by the pressure from the growing tumour. As such, a conventional, open, stent would not in itself help with reflux and could conceivably make it worse. But some stents have a valve to try and solve the problem of reflux, and it seems like this is what you are being offered. As I understand it, a stent with a valve is much the same as a stent without a valve in relation to its basic purpose of keeping the passageway clear, and the valve might make a difference in relation to reflux. (Some of the reported medical trials have not shown much difference in the effect on quality of life by the addition of the valve, but it is best to ask your medical team about this because some of the reported findings are in medical jargon).

So, the questions may be:

Does your husband need a stent anyway?

Will an anti-reflux stent have any disadvantages? (it might make no difference, but if it won't make things worse, and might make things better it would be worth thinking about).

Would there be an issue about how an anti-reflux stent copes with vomiting situations?

If a stent turns out not to be an improvement, can it be removed? (might be very difficult, and not often done?)

With all these things, some procedures work well for individuals, sometimes against the general trend, and the fact that your husband has been offered this tends to show that the medical team are probably thinking that an anti-reflux stent might be worth a try. Your husband sounds like he is having a miserable time of it, and this might mean that it is the lesser of two evils.

Our very best wishes to you both

Alan

[Swaz]

Dear Alan

Thank you very much for your helpful reply.

We have had more discussions

with the surgical team and feel reassured about the options if the stent fails (probably back to NJ & NG tubes). It's worth a go because currently my husband is only having sips of water and we would dearly love to get home and have some time together as normally as possible.

Best wishes

Swaz