Department of Gastroenterology, Tallaght University Hospital.
Department of Surgery, Tallaght University Hospital and Trinity College.
Eur J Gastroenterol Hepatol. 2021 Feb 1;32(2):157-162. doi: 10.1097/MEG.0000000000001891.
Healthcare resources are finite. Value in healthcare can be defined as patient health outcomes achieved per monetary unit spent. Attempts have been made to quantify the value of luminal endoscopy, but there is little in the medical literature describing the value of the complex therapeutic endoscopic activity. This study aimed to characterise the value of endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs) with either plastic or lumen-apposing metal stents (LAMSs).
This is a single-centre, retrospective-prospective comparative study of 39 patients, who underwent EUS-guided PFC drainage between 2009 and 2018. Procedure value was calculated using the formula Q/(T/C), where Q is the quality of procedure adjusted for complications, T procedure duration and C is the complexity adjustment. Quality and complexity were estimated on a 1-4 Likert scale based on the American Society for Gastrointestinal Endoscopy criteria. Time (in minutes) was recorded from the patient entering and leaving the procedure room. Endoscopy time calculated from procedure time was considered a surrogate marker of cost as individual components of procedure cost were not itemized.
Of 39 identified patients who underwent EUS-guided PFC drainage, 11 received double pigtail plastic stents (DPPSs) and 28 received LAMSs. The two groups were comparable in age, gender and aetiology. Nearly 40% of the LAMS interventions were considered high value but only 11% of the plastic stent interventions achieved the same. The difference predominantly was due to a higher rate of complications and longer procedure time.
In this single-centre study, EUS-guided PFC drainage using LAMS was found to be a higher value procedure compared to the use of DPPS.
医疗资源是有限的。医疗保健中的价值可以定义为每花费一个货币单位所获得的患者健康结果。人们已经尝试量化内腔镜的价值，但医学文献中几乎没有描述复杂治疗性内镜活动价值的内容。本研究旨在描述超声内镜（EUS）引导下引流胰腺液积聚（PFC）时使用塑料或内腔镜吻合金属支架（LAMS）的价值。
这是一项单中心、回顾性前瞻性比较研究，纳入了 2009 年至 2018 年间接受 EUS 引导的 PFC 引流的 39 例患者。使用公式 Q/（T/C）计算程序价值，其中 Q 是调整并发症后的程序质量，T 是程序持续时间，C 是复杂性调整。质量和复杂性根据美国胃肠内镜学会标准在 1-4 级 Likert 量表上进行评估。从患者进入和离开手术室的时间记录时间（分钟）。从手术时间中计算出的内镜时间被认为是成本的替代指标，因为未对手术成本的各个组成部分进行逐项列出。
在 39 例接受 EUS 引导的 PFC 引流的患者中，11 例接受了双猪尾塑料支架（DPPS），28 例接受了 LAMS。两组在年龄、性别和病因方面具有可比性。近 40%的 LAMS 干预措施被认为是高价值的，但只有 11%的塑料支架干预措施达到了同样的效果。差异主要是由于并发症发生率更高和手术时间更长。
在这项单中心研究中，与使用 DPPS 相比，使用 LAMS 进行 EUS 引导的 PFC 引流被认为是一种更有价值的程序。
