Economical effect of lumen apposing metal stents for treating benign foregut strictures

Abstract

AIMTo evaluate the clinical and economical efficacy of lumen apposing metal stent (LAMS) in the treatment of benign foregut strictures.METHODSA single center retrospective database of patients who underwent endoscopic treatment of benign foregut strictures between January 2014 and May 2017 was analyzed. A control group of non-stented patients who underwent three endoscopic dilations was compared to patients who underwent LAMS placement. Statistical tests performed included independent t-tests and five-parameter regression analysisRESULTSNine hundred and ninety-eight foregut endoscopic dilations were performed between January 2014 and May 2017. 15 patients underwent endoscopic LAMS placement for treatment of benign foregut stricture. Thirty-six patients with recurrent benign foregut strictures underwent three or more endoscopic dilations without stent placement. The cost ratio of endoscopic dilation to LAMS (stent, placement and retrieval) is 5.77. Cost effective analysis demonstrated LAMS to be economical after three endoscopic dilation overall. LAMS was cost effective after two dilations in the Post-surgical stricture subgroup.CONCLUSIONEndoscopists should consider LAMS for the treatment of benign foregut strictures if symptoms persist past three endoscopic dilations. Post-surgical strictures may benefit from LAMS if symptoms persist after two dilations in a post-surgical. Early intervention with LAMS appears to be a clinically and economically viable option for durable symptomatic relief in patients with these strictures.

Efficacy of lumen-apposing metal stents for the management of benign gastrointestinal stricture: a systematic review and meta-analysis

“…A 15×10-mm LAMS was the most commonly used stent, with median stent dwell time varying from 60-119 days. Our study quality assessment found that 11 were of medium quality [ 14 - 18 , 21 , 22 , 24 , 26 - 28 ] and 7 were of low quality [ 11 - 13 , 19 , 20 , 23 , 25 ] ( ).…”

Luminal-apposing stents for benign intraluminal strictures: a large United States multicenter study of clinical outcomes

“…The high reintervention rate raises concern about the cost-effectiveness of LAMS in the management of benign GI strictures, given the fact that LAMS placement is an expensive procedure. In a study evaluating the economical efficacy of LAMS in the management of benign GI strictures, Hallac et al found that LAMS placement may have an economic advantage over recurrent dilation after the third dilation [ 17 ]. In the present study, most of the strictures had already failed previous treatments.…”

Endoscopic Management of Strictures in Crohn’s Disease: An Unsolved Case

“…Lumen-apposing metal stents (LAMS) are short, fully covered metal stents with large flanges at each end to anchor the stent and minimize migration risk [53,54]. Initially designed for draining pancreatic fluid collections, LAMS has been used off-label to manage short-segment luminal strictures [55,56], with several studies showing promising outcomes.…”