Long-term outcomes of antimigration fully covered metal stents for dominant pancreatic duct strictures in children: a comparative analysis with adults

BACKGROUND AND AIMS: The use of fully covered self-expandable metal stents (FCSEMSs) in chronic pancreatitis (CP) remains limited because of stent migration concerns. We evaluated long-term outcomes of antimigration FCSEMSs in pediatric and adult patients with CP and explored their procedural economic implications. METHODS: We retrospectively analyzed 85 consecutive patients (31 pediatric and 54 adult) with CP and benign dominant pancreatic duct strictures who underwent placement of an FCSEMS with anchoring flaps at Asan Medical Center, South Korea. Clinical outcomes and stricture recurrence were evaluated. An exploratory economic analysis comparing FCSEMS with a plastic stent strategy was performed from the perspective of the Korean National Health Insurance system using 2 complementary modeling approaches. RESULTS: Technical success was 100% in both groups, with no migration. Clinical success (90.3% vs 77.8%, P = .10) and stricture resolution (96.8% vs 90.7%, P = .29) were comparable between cohorts. Pediatric patients underwent more frequent stent exchanges (median 4 vs 2, P < .001) and shorter per-stent indwelling durations. Recurrence occurred in 23.3% of pediatric and 34.7% of adult patients. In the pooled analysis adjusted for age group, a longer interval from symptomatic dominant main pancreatic duct (MPD) stricture diagnosis to FCSEMS insertion was independently associated with shorter time to recurrence (hazard ratio [HR], 1.44 per 1-year increase; 95% CI, 1.22-1.70; P < .001), suggesting that earlier FCSEMS placement (≤1 year) may lead to favorable outcomes. Exploratory economic analysis showed cost savings with FCSEMS over a plastic stent strategy in both cohorts (per-patient savings: $2125 pediatric, $2299 adult), driven by reduced ERCP session frequency. CONCLUSIONS: Antimigration FCSEMSs appear technically feasible for selected pediatric and adult patients with dominant MPD strictures in CP, with no migration and low adverse event rates. Exploratory economic analysis demonstrated cost savings in both cohorts, with particularly favorable implications for pediatric patients, in whom endoscopic therapy remains the primary modality.