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Self-Expandable Metallic Stent Is More Cost Efficient Than Plastic Stent in Treating Anastomotic Biliary Stricture

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Abstract

Background

Anastomotic bile duct stricture (ABS) is one of the most common complications after liver transplantation. Current practice of endoscopic retrograde cholangiopancreatography (ERCP) with multiple plastic stent (MPS) insertion often requires multiple sessions before achieving stricture resolution. We aimed to compare the efficacy of fully covered self-expandable metallic stent (FCSEMS) with MPS method while simultaneously analyzing the relative healthcare cost between the two methods in the management of ABS.

Methods

Liver transplant patients with ABS who received ERCP with stent placement were identified by query of our endoscopic database. Comparative analyses between the group of patients treated with ERCP with MPS and the group treated with FCSEMS were performed. The costs to achieve stricture resolution, and the rates of stricture resolution, recurrence and complications were also compared.

Results

A total of 158 patients underwent ERCP with stent insertion for the management of ABS. Of those, 49 patient received FCSEMS for their ABS while 109 patients were treated with MPS only. Our cost analysis showed early utilization of FCSEMS can deliver up to 25% savings in the total procedure cost while providing comparable rates of stricture resolution. The rates of technical success, stricture recurrence and adverse outcomes, and stricture free durations were also comparable between the two groups.

Conclusion

While providing efficacy and safety rates comparable to ERCP-MPS, the incorporation of FCSEMS at early stage of ABS management could provide a substantial savings by reducing the number of ERCP session to achieve stricture resolution. Optimization of the timing and duration of FCSEMS indwelling time needs further validation.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Q3-1, Cleveland, OH, 44195, USA

    Sunguk Jang, Tyler Stevens, Prabhleen Chahal, Amit Bhatt, Madhu Sanaka & John J. Vargo

  2. Department of Quantitative Sciences, Cleveland Clinic, Cleveland, OH, USA

    Rocio Lopez

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  1. Sunguk Jang
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  2. Tyler Stevens
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  3. Rocio Lopez
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  4. Prabhleen Chahal
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  6. Madhu Sanaka
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  7. John J. Vargo
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Contributions

SJ was involved in study conception and design, acquisition and interpretation of data, drafting of manuscript, critical revision of the manuscript for important intellectual content, and final approval of manuscript. TS contributed to study design, analysis and interpretation of data, and critical revision of the manuscript for important intellectual content, and final approval of manuscript. RL was involved in statistical analysis and interpretation and critical revision of the manuscript for important intellectual content. AB was involved in acquisition and analysis of data, critical revision of the manuscript for important intellectual content, and final approval of manuscript. PC contributed to acquisition and analysis of data, critical revision of the manuscript for important intellectual content, and final approval of manuscript. MS was involved in acquisition of data, critical revision of manuscript for important intellectual content, and final approval of manuscript. JV contributed to study design, analysis of data, critical revision of the manuscript for important intellectual content, and final approval of manuscript.

Corresponding author

Correspondence to Sunguk Jang.

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Conflict of interest

Dr. Jang reports conflict of interest with consulting service arrangement with Boston Scientific, outside the submitted work. Dr. Stevens reports conflict of interest with consulting service arrangement with Boston Scientific and AbbVie Pharmaceutical. Dr. Bhatt declares no conflict of interest. Dr. Sanaka declares no conflict of interest. Dr. Chahal declares no conflict of interest. Dr. Vargo declares no conflict of interest. Ms. Lopez declares no conflict of interest.

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Jang, S., Stevens, T., Lopez, R. et al. Self-Expandable Metallic Stent Is More Cost Efficient Than Plastic Stent in Treating Anastomotic Biliary Stricture. Dig Dis Sci 65, 600–608 (2020). https://doi.org/10.1007/s10620-019-05665-9

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  • DOI: https://doi.org/10.1007/s10620-019-05665-9

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