Case Control Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Oct 16, 2018; 10(10): 294-300
Published online Oct 16, 2018. doi: 10.4253/wjge.v10.i10.294
Economical effect of lumen apposing metal stents for treating benign foregut strictures
Alexander Hallac, Wichit Srikureja, Eashen Liu, Parag Dhumal, Ashish Thatte, Nishant Puri
Alexander Hallac, Wichit Srikureja, Eashen Liu, Nishant Puri, Providence Gastroenterology, Spokane, WA 99204, United States
Parag Dhumal, College of Business, Economics and Computing, University of Wisconsin-Parkside, Kenosha, WI 53144, United States
Ashish Thatte, School of Business Administration, Gonzaga University, Spokane, WA 99258, United States
Author contributions: Hallac A and Srikureja W designed research; Liu E, Dhumal P, Thatte A and Puri N performed research and contributed new reagents/analytic tools; all authors analyzed data and wrote the paper.
Institutional review board statement: Providence Health Care (Spokane) approves this study, and is part of the corresponding author home institution.
Conflict-of-interest statement: All authors have no conflicts of interest to report.
STROBE statement: The STROBE Statement has been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nishant Puri, MD, FACP, FACG, Providence Gastroenterology, 105 W. 8th Avenue, Suite 7050, Spokane, WA 99204, United States. npurigi@gmail.com
Telephone: +1-509-2521711 Fax: +1-509-2277070
Received: June 29, 2018
Peer-review started: June 30, 2018
First decision: July 19, 2018
Revised: July 27, 2018
Accepted: August 21, 2018
Article in press: August 21, 2018
Published online: October 16, 2018
Processing time: 109 Days and 8.1 Hours
ARTICLE HIGHLIGHTS
Research background

The use of lumen apposing metal stents (LAMS) began in 2012 as a treatment modality for pancreatic pseudocysts. Currently, LAMS are being used in various endoscopic procedures such as pancreatic pseudocyst drainage.

Research motivation

The key question of our study is How effective and economical is the use of LAMS in the treatment of benign foregut strictures.

Research objectives

The main objective of this study was to determine how to appropriately utilize LAMS in the treatment of benign foregut strictures. Benign foregut strictures frequently recur therefore this study will contribute to the literature used to determine treatment strategies for these difficult recurrent strictures.

Research methods

The research methods that were adopted to realize our objective was a single center retrospective case-control study. The case-control study was complemented by a cost effectiveness analysis.

Research results

The cost breakeven point of using a LAMS compared to repeat endoscopic dilation was 3.5 and 2.2 dilations in patients with benign foregut strictures and post-surgical strictures, respectively. Our results demonstrate that stent placement may have an economical advantage over recurrent dilation once a patient has undergone three endoscopic dilations. The optimal duration of stent placement to provide maximum efficacy and minimum adverse events remains unknown, further prospective multicenter studies are needed.

Research conclusions

This study presents the novel finding that inserting a LAMS instead of serial dilations can be a cost-effective treatment. We believe our results demonstrate that recurrent endoscopic dilation of benign foregut strictures can be optimally treated by LAMS in well selected patients. In summary, this study demonstrates that the interval between endoscopic dilations decreases overtime after each subsequent dilation. The use of LAMS for benign foregut strictures has been reported however we utilized an economic analysis to prove our hypothesis that there is a potential cost savings.

Research perspectives

This study has important clinical implications particularly in the United States where the placement of a LAMS for any reason other than evacuating a pancreatic pseudocyst is not Federal Drug Enforcement Agency approved. Endoscopists can incorporate the findings of this study into their clinical practice when treating patients whose benign foregut strictures continue to require endoscopic dilations.