Lumen‐apposing metal stents for drainage of pancreatic fluid collections: When and for whom?
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 matc...
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| Veröffentlicht in: | Digestive endoscopy 2017-01, Vol.29 (1), p.83-90 |
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| creator | Bang, Ji Young Hasan, Muhammad K. Navaneethan, Udayakumar Sutton, Bryce Frandah, Wesam Siddique, Sameer Hawes, Robert H. Varadarajulu, Shyam |
| description | 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 |
| doi_str_mv | 10.1111/den.12681 |
| format | Article |
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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.</description><identifier>ISSN: 0915-5635</identifier><identifier>EISSN: 1443-1661</identifier><identifier>DOI: 10.1111/den.12681</identifier><identifier>PMID: 27199157</identifier><language>eng</language><publisher>Australia</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Child ; Drainage - methods ; endoscopic ultrasound ; Endosonography - methods ; Female ; Humans ; lumen‐apposing metal stent ; Male ; Middle Aged ; Pancreatic Diseases - surgery ; pancreatic fluid collection ; plastic stent ; Retrospective Studies ; Stents ; Surgery, Computer-Assisted - methods ; walled‐off necrosis ; Young Adult</subject><ispartof>Digestive endoscopy, 2017-01, Vol.29 (1), p.83-90</ispartof><rights>2016 Japan Gastroenterological Endoscopy Society</rights><rights>2016 Japan Gastroenterological Endoscopy Society.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4151-59f07d80ce782f78d59d71ca18328dd8771af8f7304da4374106ef8b97c720e03</citedby><cites>FETCH-LOGICAL-c4151-59f07d80ce782f78d59d71ca18328dd8771af8f7304da4374106ef8b97c720e03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fden.12681$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fden.12681$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27199157$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bang, Ji Young</creatorcontrib><creatorcontrib>Hasan, Muhammad K.</creatorcontrib><creatorcontrib>Navaneethan, Udayakumar</creatorcontrib><creatorcontrib>Sutton, Bryce</creatorcontrib><creatorcontrib>Frandah, Wesam</creatorcontrib><creatorcontrib>Siddique, Sameer</creatorcontrib><creatorcontrib>Hawes, Robert H.</creatorcontrib><creatorcontrib>Varadarajulu, Shyam</creatorcontrib><title>Lumen‐apposing metal stents for drainage of pancreatic fluid collections: When and for whom?</title><title>Digestive endoscopy</title><addtitle>Dig Endosc</addtitle><description>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.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Case-Control Studies</subject><subject>Child</subject><subject>Drainage - methods</subject><subject>endoscopic ultrasound</subject><subject>Endosonography - methods</subject><subject>Female</subject><subject>Humans</subject><subject>lumen‐apposing metal stent</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Pancreatic Diseases - surgery</subject><subject>pancreatic fluid collection</subject><subject>plastic stent</subject><subject>Retrospective Studies</subject><subject>Stents</subject><subject>Surgery, Computer-Assisted - methods</subject><subject>walled‐off necrosis</subject><subject>Young Adult</subject><issn>0915-5635</issn><issn>1443-1661</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kDtOxDAQQC0EgmWh4ALIJRRZPM7HDg1C_KUVNCA6ImOPd4MSO8SJEB1H4IychECAjmmmmDeveITsAJvBMAcG3Qx4JmGFTCBJ4giyDFbJhOWQRmkWpxtkM4QnxoDnSbJONriAfLiJCXmY9zW6j7d31TQ-lG5Ba-xURUOHrgvU-paaVpVOLZB6SxvldIuqKzW1VV8aqn1Voe5K78IhvV-io8qZ77eXpa-PtsiaVVXA7Z89JXfnZ7cnl9H85uLq5Hge6QRSiNLcMmEk0ygkt0KaNDcCtAIZc2mMFAKUlVbELDEqiUUCLEMrH3OhBWfI4inZG71N6597DF1Rl0FjVSmHvg8FSJ5lOeMAA7o_orr1IbRoi6Yta9W-FsCKr5zFkLP4zjmwuz_a_rFG80f-9huAgxF4KSt8_d9UnJ5dj8pPQTZ_SQ</recordid><startdate>201701</startdate><enddate>201701</enddate><creator>Bang, Ji Young</creator><creator>Hasan, Muhammad K.</creator><creator>Navaneethan, Udayakumar</creator><creator>Sutton, Bryce</creator><creator>Frandah, Wesam</creator><creator>Siddique, Sameer</creator><creator>Hawes, Robert H.</creator><creator>Varadarajulu, Shyam</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201701</creationdate><title>Lumen‐apposing metal stents for drainage of pancreatic fluid collections: When and for whom?</title><author>Bang, Ji Young ; Hasan, Muhammad K. ; Navaneethan, Udayakumar ; Sutton, Bryce ; Frandah, Wesam ; Siddique, Sameer ; Hawes, Robert H. ; Varadarajulu, Shyam</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4151-59f07d80ce782f78d59d71ca18328dd8771af8f7304da4374106ef8b97c720e03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Case-Control Studies</topic><topic>Child</topic><topic>Drainage - methods</topic><topic>endoscopic ultrasound</topic><topic>Endosonography - methods</topic><topic>Female</topic><topic>Humans</topic><topic>lumen‐apposing metal stent</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Pancreatic Diseases - surgery</topic><topic>pancreatic fluid collection</topic><topic>plastic stent</topic><topic>Retrospective Studies</topic><topic>Stents</topic><topic>Surgery, Computer-Assisted - methods</topic><topic>walled‐off necrosis</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bang, Ji Young</creatorcontrib><creatorcontrib>Hasan, Muhammad K.</creatorcontrib><creatorcontrib>Navaneethan, Udayakumar</creatorcontrib><creatorcontrib>Sutton, Bryce</creatorcontrib><creatorcontrib>Frandah, Wesam</creatorcontrib><creatorcontrib>Siddique, Sameer</creatorcontrib><creatorcontrib>Hawes, Robert H.</creatorcontrib><creatorcontrib>Varadarajulu, Shyam</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Digestive endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bang, Ji Young</au><au>Hasan, Muhammad K.</au><au>Navaneethan, Udayakumar</au><au>Sutton, Bryce</au><au>Frandah, Wesam</au><au>Siddique, Sameer</au><au>Hawes, Robert H.</au><au>Varadarajulu, Shyam</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Lumen‐apposing metal stents for drainage of pancreatic fluid collections: When and for whom?</atitle><jtitle>Digestive endoscopy</jtitle><addtitle>Dig Endosc</addtitle><date>2017-01</date><risdate>2017</risdate><volume>29</volume><issue>1</issue><spage>83</spage><epage>90</epage><pages>83-90</pages><issn>0915-5635</issn><eissn>1443-1661</eissn><abstract>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.</abstract><cop>Australia</cop><pmid>27199157</pmid><doi>10.1111/den.12681</doi><tpages>1</tpages></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Case-Control Studies Child Drainage - methods endoscopic ultrasound Endosonography - methods Female Humans lumen‐apposing metal stent Male Middle Aged Pancreatic Diseases - surgery pancreatic fluid collection plastic stent Retrospective Studies Stents Surgery, Computer-Assisted - methods walled‐off necrosis Young Adult |
| title | Lumen‐apposing metal stents for drainage of pancreatic fluid collections: When and for whom? |
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