Acute colonic obstruction: clinical aspects and cost-effectiveness of preoperative and palliative treatment with self-expanding metallic stents--a preliminary report.

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Abstract
Evaluation of clinical aspects and cost-effectiveness of use of self-expanding metallic stents in the treatment of acute colonic obstruction as either a preoperative procedure or palliation. Thirteen consecutive patients, aged 49-83 years (mean, 67 years), with clinical and radiologic signs of colonic obstruction were treated as a preoperative procedure in 10 patients and as a palliative treatment in three. A total of 16 self-expanding metallic stents (diameter, 16 mm; length fully expanded, 56 mm) were implanted with combined fluoroscopic and endoscopic guidance. The costs (hospitalization, intensive care unit, stent placement, and surgery) were compared with costs for 13 surgically treated patients at the same hospital. Stent placement was successful in 12 of the 13 patients; all recovered from mechanical obstruction, and single-stage surgery was possible in eight of nine patients treated preoperatively. One very narrow stenosis could not be passed. Dysfunction occurred in two long stenoses after 5 days with reocclusion 2 and 6 weeks, respectively, after stent placement. A cost reduction of 19.7% was observed as a result of shorter hospitalization and a lower complication rate. In patients with colon cancer in the preoperative treatment group, the cost reduction increased to 28.8%. Metallic stent placement in patients with acute colonic obstruction was a minimally invasive and cost-effective preoperative procedure that allowed single-stage surgery in most cases. Stent placement for palliation should be limited to patient with special indications.

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