Lumen Apposing Metal Stents (LAMS) for Drainage of Pancreatic Fluid Collections: When and for whom?

Background and Aim

Although lumen-apposing metal stents (LAMS) are increasingly being used for drainage of pancreatic fluid collections (PFCs), 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, re-interventions, 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. 25mins, p < 0.001), there was no significant difference in treatment success (95.0 vs. 92.5%, p = 0.99), re-interventions (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. While 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

While 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 utilization of LAMS in sicker patients.

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