Published online Oct 16, 2018. doi: 10.4253/wjge.v10.i10.294
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
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.
The key question of our study is How effective and economical is the use of LAMS in the treatment of benign foregut strictures.
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.
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.
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.
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.
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.