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

Table 1 The mean time between dilations for all patients in the recurrent dilation group

	n	Mean time between dilations (d)	SD	t	P
Male	20	146.8	169.7	-0.01	0.9
Female	16	147.5	141.1
Non-Surgical	31	137.6	159.9	-1.1	0.3
Surgical	5	205.7	121.4

Table 2 Pre and post lumen apposing metal stent details for the all patients who underwent endoscopic treatment during a 40-mo period at a non-university tertiary care center

Patient	Age(yr)	Gender	Anastomotic Stricture(Yes/No)	Stricture location	Prior foregut surgery	EGD dilations prior to stenting	Duration of stent insertion (d)	Stent migration(Yes/No)	Adverse Events	Symptomatic relief	Post stent Interventions
1	59	M	Yes	GJ	RYGB	2	168	No	No	Yes	No
2	46	F	Yes	GJ	RYGB	3	91	No	No	Yes	No
31	62	F	Yes	GJ	Distal gastrectomy	3	90	No	No	Yes	Surgical Revision
41	86	M	No	Pyloric channel	Subtotal gastrectomy	3	138	No	No	Yes	No
51	90	M	No	Distal esophagus	Nissen fundoplication	3	91	No	No	Yes	No
6	78	F	No	Distal esophagus	Nissen fundoplication	4	31	No	No	Yes	No
7	65	F	No	Pyloric channel	No	2	< 159	Yes	No	Yes	No
81	65	F	No	Mid Gastric Body	VBG	1	Stent 1: 184,	No	No	Yes	Surgical VBG removal
							Stent 2: 162
9	73	F	No	Pyloric channel	No	2	98	No	No	Yes	No
10	78	F	No	Mid Gastric Body	VBG	3	-	-	No	Yes	-
11	72	M	Yes	EG	ILE	0	50	No	No	Yes	No
121	56	M	Yes	EG	ILE	4	15	No	Yes-Chest pain	No	Yes-EGD dilation
131	73	F	Yes	EG	Total gastrectomy	3	7	No	Yes-Abdominal Pain	No	Yes-EGD dilation
14	69	M	No	First duodenal segment	No	1	Stent 1: 116	No	No	No	-
							Stent 2: 265
15	78	M	No	Duodenal bulb	No	3	20	No	Yes- Obstructive jaundice from stent pressure	No	-

¹Indicates patients included in the multivariate regression analysis. M: Male; F: Female; GJ: Gastro-jejunal anastomosis; RYGB: Roux-en-Y gastric bypass; VBG: Vertical band gastroplasty; EG: Esophago-gastric anastomosis; D1: Duodenal segment 1; D2: Duodenal segment 2.

Table 3 Regression analysis of the time between dilation (d) for patients who underwent lumen apposing metal stent placement

	R2	Intercept	Coefficient	F	P
Mean overall	68.3%	220.3	-27.8	8.6	0.04
Mean female	16.9%	192	-17.4	0.8	0.41
Mean male	96.1%	250	-39.3	99.3	0.001
Mean surgical	62.2%	96.2	-63.3	6.5	0.06
Mean nonsurgical	62.8%	188.3	-19.4	6.7	0.06

Table 4 The comparison of clinical outcomes in the lumen apposing metal stent and recurrent dilation groups

	Group	n	Mean symptom free days	SD	t	P (two tail)
Overall	Dilation	36	153	153.7	2.9	0.01
	LAMS	8	327	156.9
Male	Dilation	20	147	169.04	3.5	0.01
	LAMS	3	347	73.7
Female	Dilation	16	160	137.2	2.1	0.09
	LAMS	5	353	190.9
Nonsurgical	Dilation	31	144	158.7	1.5	0.26
	LAMS	3	298	165.6
Surgical	Dilation	5	209	114.08	2.06	0.07
	LAMS	5	382	148.8

LAMS: Lumen apposing metal stent.

Table 5 The economic analysis for lumen apposing metal stent utilization

	MSFD	MSFD/Cost Ratio	MTBD	Coefficient from Regression	Breakeven n
Overall	327	56.7	153	27.8	3.4
Male	347	60.1	147	39.3	2.2
Surgical	382	66.2	209	63.3	2.2

MSFD: Mean symptom free days; MTBD: Mean time between dilations (d).