EUS-Guided Cyst-Enterostomy Using a Self-Expanding Metal Stent Is a More Cost-Effective Strategy for the Treatment of Pancreatic Fluid Collections
Bibliographic record
Abstract
Introduction: EUS-guided cyst-enterostomy (EUS-CE) has become the mainstay for endoscopic treatment of symptomatic pancreatic fluid collections (PFCs). The traditional approach (Approach I) of inserting multiple double-pigtail plastic stents with sequential dilation of the tract with or without nasocystic irrigation is successful but requires repeated endoscopic intervention. The comparative effectiveness of newer approaches utilizing a fully covered expandable metal stent (FCEMS, Approach II) is not understood very well.Our aim is to compare the clinical efficacy and cost impact of these approaches in the management of PFCs. Methods: We include all patients that underwent EUS-CE for PFCs. Clinical efficacy was defined as symptomatic improvement and cyst resolution on cross-sectional imaging. Follow-up was until stent removal. The total cost was calculated for each EUS-CE (including anesthesia and radiology costs), all subsequent procedures and hospital length of stay (HLOS). Results: Between 11/2010 and 03/2016, 12 patients underwent Approach I and 16 patients underwent Approach II. Patients in Approach I had a mean of 3.9 endoscopic interventions (range 1-8), mean procedure time of 72 min (range 43-130 min) and 11.4 days of HLOS (range 0-33 days) compared with 1 endoscopic intervention, mean procedure time of 39 min (range 16-65 min) and 2.2 days HLOS (range 0-7 days) in Approach II (p=0.001, p=0.01 and p=0.02, respectively). Cyst resolution was documented in 12/12 patients with a mean follow-up of 284 days in Approach I (range 86-628 days) and 15/16 patients with a mean follow-up of 98 days in Approach II (range 1-239 days). There were 6 adverse events in Approach I compared with 2 in Approach II (p=0.03). The average cost of Approach I was $17,590 compared with $6,165 for Approach II (p=0.01). Conclusion: Despite the increased upfront cost of a metal stent, the use of a FCEMS for EUS-CE in the treatment of PFCs is effective, safe and results in significant overall cost savings by reducing the number of endoscopic re-interventions and HLOS.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".