LONG-TERM EFFICACY AND COST EFFECTIVENESS OF ENDOSCOPIC TREATMENT OF PANCREATIC PSEUDOCYSTS: PIGTAIL VS SELF EXPANDING METAL STENTS (SEMS)

Aims:

Currently endoscopic therapy is a gold standard management option of pancreatic pseudocysts. However, particular type of stent application in larger pseudocysts is still debated, especially regarding long-term outcomes and costs. Therefore, we hypothesized that due to its larger diameter and improved drainage SEMS would be as efficacious and cost effective as pigtail stents in resolving pseudocysts larger than 6 cm.

Methods:

To test the hypothesis we conducted a retrospective cohort study into patients who underwent endoscopic pancreatic pseudocystogastrostomy in VULSK during 2012 – 2017. Patients were followed up for 6 months when according to local protocol stent should be removed. We collected demographic (age, gender) and clinical data (stent type, size of the pseudocyst, presence of infection, bleeding, sequential operation, resolution of the cyst, number of days admitted in 6 months, number of endoscopies performed) from hospital records. Economics department provided the data regarding treatment costs. For statistical analysis we used R statistical package. To compare the groups we used Chi-square, Fisher-exact test and t-test. Results were considered statistically significant if p < 0,05.

Results:

Our study comprised 49 patients, 75% of whom were men. All drainage procedure were done under EUS guidance and during 6 months of follow-up all patients attained pseudocyst resolution. Main findings are summarized in Table 1.

Tab. 1

	ALL	PIGTAIL	SEMS	p
Patients	49	33	16
Bleeding in 6 months	4 (8%)	4 (12.1%)	0 (0.0%)	0,37
Days of hospitalization in 6 months	15,94 (± 16,22)	18.33 (± 19.19)	11.00 (± 4.21)	0,139
Treatment cost in 6 months (EUR)	3801.53 (± 3836.35)	3987.50 (± 4135.59)	2760.12 (± 835.18)	0,519

Conclusions:

In patients with large pancreatic pseudocyst, pancreatogastrostomy with SEMS is at least as efficient and cost effective as drainage with pigtail stents.

A larger prospective randomized controlled trial would provide definite guidance for best clinical and economic practice.