Colonic stent versus surgery for the management of acute malignant colonic obstruction: A decision analysis

A. Siddiqui, N. Khandelwal, T. Anthony, S. Huerta

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

Background: Acute colonic obstruction because of advanced colonic malignancy is a surgical emergency. Aim: To compare the clinical outcomes and cost-effectiveness of endoscopic self-expanding metal stent (SEMS) vs. surgery for emergent management of acute malignant colonic obstruction in patients with metastatic colorectal cancer over a 6-month period. Methods: Decision analysis was used to calculate the cost-effectiveness and success of two competing strategies in a hypothetical patient with metastatic colon cancer presenting with acute, malignant colonic obstruction: (i) emergent colonic stent (SEMS cohort); (ii) emergent surgical resection followed by diversion (surgery cohort). Results: Self-expanding metal stent resulted in a success and a lower mortality rate when compared to surgery over a 6-month period. Colonic SEMS was also associated with a lower mean cost per patient ($27 225 vs. $57 398). Mortality in the surgery group was 25 times that of the SEMS cohort. One- and two-way sensitivity analyses identified SEMS as the dominant strategy. Conclusion: Colonic stent insertion is more effective and less costly than surgery for the management of colonic obstruction in patients with metastatic colon cancer.

Original languageEnglish (US)
Pages (from-to)1379-1386
Number of pages8
JournalAlimentary Pharmacology and Therapeutics
Volume26
Issue number10
DOIs
StatePublished - Nov 2007

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology
  • Pharmacology (medical)

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