Oña-Ortiz FM, De la Mora-Levy JG, Jiménez-Morales M, Alonso-Lárraga JO, Sánchez-del Monte J, Ramírez-Solís ME, Yañez-Cruz M, Hernández-Guerrero A

Language: Spanish
References: 11
Page: 5-10
PDF size: 525.19 Kb.

ABSTRACT

Introduction. The Endoscopic Retrograde Cholangiopancreatography (ERCP) along stenting is the current standard treatment for malignant biliary obstruction. Initially the plastic stents (PS) are less expensive than metal stents (MS). The MS have proven to be more cost-efficient than the PS for patients with a life expectancy of more than 6 months in terms of final cost, with less reinterventions and complications. In Mexico, the MS are scarcely used in public institutions due to its apparent high cost. However, the institutional cost for the use of either type of stent is yet to be analyzed. Our objective was to establish which is the best approach on patients with malignant biliary tract obstruction in the Mexican population; aiming to a decision-making based on objective data and real information of the population.
Material and Methods. Prospective analysis from a data base of patients who underwent a ERCP and stenting for malignant biliary tract in tertiary public oncological hospital.
Results. 142 patients who had an ERCP and stenting for malignant biliary stenosis were included. 102 were handled with plastic (PS), and 40 with metal (MS). The average permeability was 109 days in the group of patients with PS, and 135 days for patients with MS ( p=0.24). In the group of patients with PS 1.64 procedures were performed vs 1.13 for the group of patients with MS (p‹0.01). 53% (50/93) of the patients with PS showed a sort of complication vs 17% (7/39) for the group of patients with MS (p‹0.01). The corrected or real cost was 1.64 for the group of plastic stents (($43,689 MXN) and 1.13 for the MS ($58,222 MXN). From a clinical standpoint, the cost of PS exceeded the price of MS, starting from the 2 medical procedures with more reinterventions and complications during the permeability of the stent, establishing this as the breaking point of equivalence between two groups with MS having a higher benefit.
Discussion. The use of metallic stent is comparable to the use of plastic stent if we consider the institutional cost. The cost of the plastic stents is higher than the metallic stent after there are two interventions.

REFERENCES

1. 1.Speer AG, Cotton PB, Russell RC, et al. Randomized trial of endoscopic versus percutaneous stent insertion in malignant obstructive jaundice. Lancet. 1987;2:57–62.

2. Pinol V, Castelis A, Bordas JM, et al. Percutaneous self- expanding metal stents versus endoscopic polyethylene endo- prothesis for treating malignant biliary obstruction: randomized clinical trial. Radiology. 2002;225:321–324.

3. Katsinelos P, Paikos D, Kountouras J, et al. Tannenbaum and metal stents in the palliative treatment of malignant distal bile duct obstruction: a comparativestudy of patency and cost effectiveness. Surg Endosc. 2006;51:23–27.

4. Ramu P. Raju, Sathya R. Jaganmohan, et al. O p t i mu m Palliation of Inoperable Hilar Cholangiocarcinoma: Comparative Assessment of the Efficacy of Plastic and Self-Expanding Metal Stents. Springer; (2011) 56:1557–1564.

5. Arguedas MR, Heudebert GH, Stinnett AA, Wilcox CM. Biliary stents in malignant obstructive jaundice due to pancreatic carci- noma: a cost-effectiveness analysis. Am J Gastroenterol. 2002; 97:898–904.

6. Moss AC, Morris E, Leyden J, MacMathuna P. Do the benefits of metal stents justify the costs? A systematic review and meta- analysis of trials comparing endoscopic stents for malignant biliary obstruction. Eur J Gastroenterol Hepatol. 2007;19: 1119–1124.

7. Van Laethem JL, De Broux S, Eisendrath P, et al. Clinical impact of biliary drainage and jaundice resolution in patients with obstructive metastases at the hilum. Am J Gastroenterol. 2003;98: 1271–1277.

8. de Groen PC, Gores GJ, LaRusso NF, et al. Biliary tract cancers. N Engl J Med. 1999;341:1368–1378.

9. David G. Perdue, MD, MSPH, Martin L. Freeman, MD et al. Plastic Versus Self-expanding Metallic Stents for Malignant Hilar Biliary Obstruction. Clin Gastroenterol.2008; 42( 9).

10. Dumonceau JM, Tringali A, Blero D, Devière J, Laugiers R, Heresbach D, Costamagna G. European Society of Gastrointestinal Endoscopy. Biliary stenting: indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guide- line. Endoscopy 2012; 44:277–298.

11. Fotios Sampaziotisa,c, Joshua Elias et al. A retrospective study assessing fully covered metal stents as first-line management for malignant biliary strictures. Eur J Gastroenterol Hepatol 27:1347–1353