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The most comprehensive academic health center in Texas, The University of Texas Health Science Center at Houston (UTHealth) is home to six schools devoted to medicine, nursing, public health, dentistry, health informatics and graduate studies in biomedical science. UTHealth, founded in 1972, is part of The University of Texas System. It is a state-supported health institution whose state funding is supplemented by competitive research grants, patient fees and private philanthropy.

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Meredith Raine

From time to time, Helene Wilcox would have stomach pain so severe that doctors thought she might be having a heart attack.

Her intermittent stomachache went on for three years, but no one could find the underlying cause of her pain. Then suddenly in the fall of 2004, Wilcox lost her appetite and became jaundiced.

The diagnosis was pancreatic cancer. The tumor was pressing against her small bowel, causing a blockage that prevented her from eating.

Traditionally, pancreatic cancer patients who develop this complication have had only one option for reopening the small bowel to allow food to digest properly. Surgeons would perform an operation to bypass the blockage. Patients were in the hospital for at least a week, and the recovery was lengthy.

Now, with the use of a self-expanding stent similar to those used for heart patients, UT physicians can reopen the blockage during an outpatient procedure and patients can eat later that day.

Douglas G. Adler, M.D., director of gastrointestinal endoscopy at The University of Texas Medical School at Houston, said the stent is one of the most important advances in the treatment of pancreatic cancer in the last 30 years.

The device does not treat or cure the cancer, but it protects the gastric outlet and allows patients to maintain a proper diet. It works like scaffolding to keep the small bowel from caving in.

Adler said the stent—currently the only device of its kind approved by the U.S. Food and Drug Administration for the small bowel—is beneficial for patients with inoperable tumors, as well as for those who are candidates for surgery to remove the cancer of the pancreas.

“It is a no-lose scenario for patients,” said Adler, assistant professor of medicine in the Division of Gastroenterology, Hepatology and Nutrition. “The stent can either serve as a bridge to surgery, or it can be used to palliate patients who are living out their days without surgery.”

Adler first began using the stents when he was at the Mayo Clinic in Rochester, Minn. Research that he and his colleague Dr. Todd Baron published in 2002 in the American Journal of Gastroenterology showed that the stents are safe and effective for relieving malignant gastric outlet obstruction. The majority of the patients in the study did not require further interventions to reopen blocked intestines, and for the small percentage of patients who did, most could be corrected without surgery via other endoscopic procedures.

Adler, one of only a few physicians in the Houston area who offers the stent, said no incisions are required. The patient is put under conscious sedation. Adler then runs an endoscope through the patient’s mouth down to the small bowel. With the assistance of a catheter in the endoscope, endoscopic images and a fluoroscopic feed, Adler guides the stent into place.

“It’s very low risk,” Adler said. “Almost all patients can eat the same day. They may regain their appetites, and most do very well with the stent.”

Wilcox, 83, said she felt no pain or nausea when she woke up from the procedure. “I felt more like eating. They were serving these stuffed potatoes, and they were so good,” she said. “I actually ate too much.”

Wilcox said her appetite still isn’t back to normal, and that most likely it is because of the cancer, but she eats six small meals a day.

“Before I was diagnosed, I didn’t realize the food couldn’t pass from the stomach to the intestines,” she said. “I just didn’t feel like eating. Now, I can eat. I am German, and I look forward to a really good pork roast and potato dumplings.”

Last Updated: 10-05-2005

 

The most comprehensive academic health center in Texas, The University of Texas Health Science Center at Houston (UTHealth) is home to six schools devoted to medicine, nursing, public health, dentistry, health informatics and graduate studies in biomedical science. UTHealth, founded in 1972, is part of The University of Texas System. It is a state-supported health institution whose state funding is supplemented by competitive research grants, patient fees and private philanthropy.