Introduction Recently, purpose designed stents have become available for EUS guided cystgastrostomy and drainage of walled of pancreatic necrosis (WON). The first such stent is a bi-flanged metal stents (BFMS). Bi-flanged metal stents (BFMS) have shown promise in the drainage of walled-off pancreatic necrosis (WON) but require multiple steps and use of other devices for placement. More recently, a novel device consisting of a combined lumen-apposing metals stent (LAMS) and electrocautery-enhanced delivery system has been introduced. This enables a single device to be used when previously multiple devices and steps were required with potential time saving and reduced immediate adverse events.The LAMS is considerably more expensive than the BFMS stent. Studies comparing BFMS to the new generation single step LAMS are lacking.
Aims To compare procedure time, technical and clinical success, costs and composite endpoint of significant events (adverse events, stent migration, additional percutaneous drainage) between BFMS and LAMS.
Method Retrospective review of consecutive BFMS/LAMS cases between October 2012 and December 2016, in a prospectively maintained database, undergoing EUS guided drainage of symptomatic WON.
Results A total of 77 patients underwent consecutive BFMS (44) and LAMS (33) placement. Successful placement was achieved in 91% BFMS and 97% LAMS. Median [range] in-room procedure time was significantly shorter (45 [30-80] minutes vs 62.5 [35-135], p<0.0001) and fewer (DEN) were performed (median 1 [0–8] vs 2 [0–11], p=0.005) in the LAMS group. Excluding ambulatory care patients, comparable direct endoscopic necrosectomies (DEN) procedures were found between 35 BFMS 2 [0–11] and 19 LAMS 2 [0–8] patients. Composite endpoint 30% vs 21% and clinical success 65% vs 78% were comparable. Mean [95% CI] procedural costs for BFMS were £4551 [3738–5363] ($5669) versus £4263 [3182–5344] ($5310) for LAMS; p=ns
Conclusion The LAMS was superior to the BFMS in terms of procedure time with comparable adverse events, success and costs.
Disclosure of Interest None Declared
- eus cystogastrostomy