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
Abstract
AIM

To evaluate the clinical and economical efficacy of lumen apposing metal stent (LAMS) in the treatment of benign foregut strictures.

METHODS

A single center retrospective database of patients who underwent endoscopic treatment of benign foregut strictures between January 2014 and May 2017 was analyzed. A control group of non-stented patients who underwent three endoscopic dilations was compared to patients who underwent LAMS placement. Statistical tests performed included independent t-tests and five-parameter regression analysis

RESULTS

Nine hundred and ninety-eight foregut endoscopic dilations were performed between January 2014 and May 2017. 15 patients underwent endoscopic LAMS placement for treatment of benign foregut stricture. Thirty-six patients with recurrent benign foregut strictures underwent three or more endoscopic dilations without stent placement. The cost ratio of endoscopic dilation to LAMS (stent, placement and retrieval) is 5.77. Cost effective analysis demonstrated LAMS to be economical after three endoscopic dilation overall. LAMS was cost effective after two dilations in the Post-surgical stricture subgroup.

CONCLUSION

Endoscopists should consider LAMS for the treatment of benign foregut strictures if symptoms persist past three endoscopic dilations. Post-surgical strictures may benefit from LAMS if symptoms persist after two dilations in a post-surgical. Early intervention with LAMS appears to be a clinically and economically viable option for durable symptomatic relief in patients with these strictures.

Keywords: Benign esophageal stricture, Endoscopy economics, Stent economics, Self expandable metallic stents, Esophageal diseases

Core tip: The findings of our study will be helpful with clinical decision making when treating benign strictures of the esophagus and foregut. The main finding of our study is that lumen apposing metal stents have the potential to have an economical advantage over repeated dilations in the treatment of recurrent benign foregut strictures. Reports of placing lumen apposing stents as an alternative to serial endoscopic dilation have been reported, however no economic analysis has been published.