d and Drug Administration cleared the “Dua Esophageal Stent” for use by patients with esophageal cancer in 2002. Using a similar windsock design, Dr. Dua modified the valve and attached it to the bile duct stent that closes whenever the pressure in the intestines increases so as to prevent backflow into the bile ducts.

Laboratory studies to evaluate the flow dynamics of this modified stent showed that its valve was effective in reducing backflow while maintaining its primary function, namely forward flow.

Dr. D.N. Reddy from the Asian Institute of Gastroenterology in Hyderabad, India, conducted a study on 60 consecutive patients in whom the bile duct was obstructed from cancer of the pancreas or the bile duct. He placed a standard biliary stent in 30 patients and the Dua stent in the remaining 30 patients.

Addition of the anti-reflux valve on the Dua stent did not compromise the main function of the stent, i.e. bile drainage as both stents were equally effective in improving liver tests, and complication rates were similar.

The study showed that the stent with the Dua anti-reflux valve remained functional for a median of 145 days compared to 90 days in those with a standard stent. This resulted in fewer repeat endoscopies for stent changes in patients with the Dua stent. There were six patients in the anti-reflux stent group in whom the stent remained patent for six months and longer compared to only one such patient in the standard stent group.

“In patients with advanced cancers causing bile duct obstruction in whom life expectancy is limited, this difference may translate into fewer procedures to maintain bile duct patency. That means a better quality of life for these cancer patients,” says Dr. Dua.

“Our next step is to do electron microscopic analysis of clogged standard and anti-reflux stents to evaluate the role of reflux of intestinal contents in stent clogging,” Dua says. “We also hope t
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