Acute colonic obstruction because of malignancy is often a surgical emergency.
Surgical decompression with colostomy with or without resection and eventual re-anastomosis is the traditional treatment of choice.
Endoscopic colonic stent insertion effectively decompresses the obstructed colon, allowing for surgery to be performed electively.
Dr Farrell and colleagues from Los Angeles in America undertook a study in order to determine the cost-effectiveness of colonic stent vs. surgery for emergent management of acute malignant colonic obstruction.
The researchers used decision analysis to calculate the cost-effectiveness of 2 competing strategies in a hypothetical patient presenting with acute, complete, malignant colonic obstruction.
The first strategy examined was using an emergent colonic stent followed by elective surgical resection and re-anastomosis.
|Colonic stent procedure resulted in 23% fewer operative procedures per patient|
The researchers copmpared the outcomes of this technique with the outcomes of emergent surgical resection followed by diversion (Hartmann's procedure) or primary anastomosis.
The research team obtained cost estimates from a third-party payer perspective.
Primary outcome measures were mortality, stoma requirement, and total number of operative procedures.
The researchers found that colonic stent procedure resulted in 23% fewer operative procedures per patient, an 83% reduction in stoma requirement, and lower procedure-related mortality.
The research team noted that the colonic stent procedure was associated with a lower mean cost per patient ($45,709 vs. $49,941).
Dr Farrell concluded, "Colonic stent insertion followed by elective surgery appears more effective and less costly than emergency surgery under base-case conditions."
"This finding remains robust over a wide range of assumptions for clinical inputs in sensitivity analysis."
"Our findings suggest that colonic stent insertion should be offered, whenever feasible, as a bridge to elective surgery in patients presenting with malignant colonic obstruction."