Targownik LE et al. (2004) Colonic stent vs. emergency surgery for management of acute left-sided malignant colonic obstruction: a decision analysis. Gastrointest Endosc 60: 865–874

Patients presenting with acute malignant colonic obstruction often undergo emergency surgery, although this is associated with significant mortality and morbidity. An alternative approach is to use a colonic stent to decompress the obstruction, followed by elective surgery. Targownik et al. have compared these two strategies in their recent decision analysis.

The authors created a hypothetical patient with acute, complete, malignant colonic obstruction and compared the costs and outcomes of emergent surgical resection followed by diversion or primary anastomosis with those for elective resection and re-anastomosis following stent placement. Published reports were used to estimate the probability of outcomes such as surgical mortality or stent-related complications.

The colonic stent strategy was superior to emergency surgery in terms of procedure-related mortality (5% vs 11%), stoma requirement (7% vs 43%) and the number of operative procedures per patient (1.01 vs 1.32). Taking into account the fees for hospitals, surgeons and physicians and other costs such as stents and stoma care, the stenting strategy also carried a lower mean cost per patient than did emergency surgical management ($45,709 vs $49,941).

Concluding that colonic stenting and elective surgery was more effective and less expensive than emergency surgery, Targownik et al. recommend that stenting should be offered as the first-line therapy to appropriate patients.