title: Lumen-apposing metal stents for drainage of pancreatic fluid collections: When and for whom?
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, USA.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Bang
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, USA.
authors.forename: Muhammad K
authors.initials: MK
authors.lastname: Hasan
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, USA.
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, USA.
authors.forename: Bryce
authors.initials: B
authors.lastname: Sutton
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, USA.
authors.forename: Wesam
authors.initials: W
authors.lastname: Frandah
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, USA.
authors.forename: Sameer
authors.initials: S
authors.lastname: Siddique
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Hawes
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, USA.
authors.forename: Shyam
authors.initials: S
authors.lastname: Varadarajulu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D004322:Drainage / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D025321:Surgery, Computer-Assisted / Q000379:methods*; D055815:Young Adult
keywords: endoscopic ultrasound; lumen-apposing metal stent; pancreatic fluid collection; plastic stent; walled-off necrosis