Lumen‐apposing metal stents for drainage of pancreatic fluid collections: When and for whom?

• DOI: 10.1111/den.12681
• Publication Date: 2016-05-21T15:19:41Z
• Authors: Ji Young Bang; Muhammad K. Hasan; Udayakumar Navane...; Bryce Sutton; Wesam Frandah; Sameer Siddique; Robert H. Hawes; Shyam Varadarajulu
• Keywords: Adult; Aged, 80 and over; Male; Adolescent; Pancreatic Diseases; Middle Aged; Endosonography; 3. Good health; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Surgery, Computer-Assisted; Case-Control Studies; Drainage; Humans; Female; Stents; Child; Aged; Retrospective Studies

Background and AimAlthough lumen‐apposing metal stents (LAMS) are increasingly being used for drainage of pancreatic fluid collections (PFC), their advantage over plastic stents is unclear.MethodsIn 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.ResultsAt 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).ConclusionsAlthough 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.