ACUTE COLONIC OBSTRUCTION - CLINICAL ASPECTS AND COST-EFFECTIVENESS OF PREOPERATIVE AND PALLIATIVE TREATMENT WITH SELF-EXPANDING METALLIC STENTS - A PRELIMINARY-REPORT

PURPOSE: Evaluation of clinical aspects and cost-effectiveness of use of self-expanding metallic stents in the treatment of acute colonic ob struction as either a preoperative procedure or palliation. MATERIALS AND METHODS: Thirteen consecutive patients, aged 49-83 years (mean, 67 years), with clinical and radiologic signs of colonic obstruction wer e treated, as a preoperative procedure in 10 patients and as a palliat ive treatment in three. A total of 16 self-expanding metallic stents ( diameter, 16 mm; length fully expanded, 56 mm) were implanted with com bined fluoroscopic and endoscopic guidance. The costs (hospitalization , intensive care unit, stent placement, and surgery) were compared wit h costs for 13 surgically treated patients at the same hospital. RESUL TS: Stent placement was successful in 12 of the 13 patients; all recov ered from mechanical obstruction, and single-stage surgery was possibl e in eight of nine patients treated preoperatively. One very narrow st enosis 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 shor ter hospitalization and a lower complication rate. In patients with co lon cancer in the preoperative treatment group, the cost reduction inc reased to 28.8%. CONCLUSION: Metallic stent placement in patients with acute colonic obstruction was minimally invasive and cost-effective p reoperative procedure that allowed single-stage surgery in most cases. Stent placement for palliation should be limited to patients with spe cial indications.