Premium
Lumen‐apposing metal stents for drainage of pancreatic fluid collections: When and for whom?
Author(s) -
Bang Ji Young,
Hasan Muhammad K.,
Navaneethan Udayakumar,
Sutton Bryce,
Frandah Wesam,
Siddique Sameer,
Hawes Robert H.,
Varadarajulu Shyam
Publication year - 2017
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12681
Subject(s) - medicine , pancreatic pseudocyst , adverse effect , stent , surgery , lumen (anatomy) , significant difference , retrospective cohort study , pancreatitis
Background and Aim Although lumen‐apposing metal stents (LAMS) are increasingly being used for drainage of pancreatic fluid collections (PFC), their advantage over plastic stents is unclear. Methods In this retrospective case–control study, 20 patients who underwent PFC drainage using LAMS were matched with 40 patients treated with plastic stents according to PFC type (walled‐off necrosis [WON] vs pseudocyst) and procedural technique (conventional vs multi‐gate). Main outcome measures were treatment success, reintervention, clinical and stent‐related adverse events, procedural duration, length of hospital stay (LOS) and hospital costs. Results At median follow up of 570 days, except for median procedural duration (8.5 vs 25 min, P < 0.001), there was no significant difference in treatment success (95.0 vs 92.5%, P = 0.99), reintervention (25.0 vs 30.0 %, P = 0.77), clinical (10.0 vs 12.5 %, P = 0.99) and stent‐related adverse events (10.0 vs 2.5 %, P = 0.26) or median LOS (2 [IQR 1–5] vs 2 [IQR 1–7] days, P = 0.58) between patients treated with LAMS versus plastic stents. Although there was no difference for WON ($16 708 for LAMS vs $17 221 for plastic stents, P = 0.90), mean hospital costs were significantly lower for pseudocysts using plastic stents ($18 996 vs $58 649, P = 0.03). Conclusions Although there is no difference in clinical outcomes, treating pseudocysts using plastic stents is less expensive. It is also possible that the short procedural duration is a surrogate marker for procedural complexity and this may drive the use of LAMS in sicker patients.