Palliation of inoperable malignant colonic obstruction.Comparison and cost effectiveness analysis between stent placement and stoma creation

Abstract

SUMMARY
Aim: Comparison of efficacy, safety and cost of palliative
endoscopic treatment with auto-expanding metal stents with
the stoma creation in the management of patients with
inoperable malignant colonic obstructions. Method: Thirty
patients with inoperable (metastases, hemodynamic or
pulmonary instability) malignant partial obstruction in the
left colon due to colorectal or ovarian cancer were included
in the study. Fifteen were randomized to undergo palliative
metallic colonic stent placement and 15 to undergo stoma
creation. The efficacy and safety of each method was
compared and cost-effectiveness analysis was performed,
including the cost of post-interventional care. Results:
Stents were placed successfully in 14 of 15 patients. In one
case with obstruction of a tortuous rectosigmoid flexure,
colon stenting was not possible. The patient was excluded
from the study. During follow up, a moderate nonocclusive
ingrowth of tumor into the stent lumen was observed in 6
patients, who were treated with introspective laser application.
The performed cost-effectiveness analysis showed
that although the stoma creation procedure was less
expensive, the total average difference in cost between the
two methods was 6.9% (132 Euros). Conclusions: Selfexpanding
metallic stent placement is a palliative method,
alternative to colostomy, for patients with inoperable
malignant colonic strictures, which additionally provides a better quality of life without the psychological repercussions
of a colostomy and appears to be cost-effective.
Key words: Self-expanding metal stents, Inoperable malignant
colonic obstructions, Cost-effectiveness analysis,
Colostomy