Annals of Coloproctology

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Colorectal cancer

Colonic stenting: is the bridge to surgery worth its cost? A cost-effectiveness analysis at a single Asian institution: Michelle Shi Qing Khoo, Frederick H. Koh, Sharmini Su Sivarajah, Leonard Ming-Li Ho, Darius Kang-Lie Aw, Cheryl Xi-Zi Chong, Fung Joon Foo, Winson Jianhong Tan; Ann Coloproctol. 2024;40(6):555-563. Published online August 5, 2024; DOI: https://doi.org/10.3393/ac.2023.00738.0105

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Purpose
In patients with acute left-sided colonic obstruction, stenting can convert an emergency operation into a semi-elective procedure. However, its use continues to be debated. We performed a cost-effective analysis using our institution’s experiences.
Methods
Endoscopic, surgical, and financial details were prospectively collected for patients who presented with acute colonic obstruction and underwent stenting between 2019 and 2022. Outcomes were defined as technical/clinical success and successful surgical resection. The financial cost of stenting was compared with the expected cost without stenting.
Results
Forty patients were included, with 29 undergoing definitive resection. The most common pathology was primary colon cancer (27 patients, 93%). Endoscopic stenting had high technical (90%) and clinical (83%) success rates, with low rates of complications such as perforation (2 patients, 7%) and migration (0 patients, 0%). As a bridge to surgery, the median procedure time was 226 minutes and the surgical outcomes also showed a low rate of complications (3 patients, 11%), such as anastomotic leakage (0 patients, 0%), intraabdominal abscesses (2 patients, 7%), and 30-day postoperative mortality (0 patients, 0%). The cumulative costs with colonic stenting were $32,900, while the expected costs with emergency surgery, including stoma reversal, were $40,700 (healthcare cost-savings of $7,800 per person). The difference was mainly due to the avoidance of upfront emergency surgery. The incremental cost-effectiveness ratio was 0.81, favoring colonic stenting over upfront emergency surgery.
Conclusion
Colonic stenting as a bridge to surgery is safe and cost-effective for treating left-sided colonic obstruction with high success rates and low complication rates.

Citations

Citations to this article as recorded by

Nationwide Analysis of Right-Sided Colonic Stenting: Rarely Used but Reduces Stoma Creation Significantly
Khalid Ahmed, Ahmed Dirweesh, Zachary D. Leslie, Yasmin Ali, Nabeel Azeem, Eric Wise, Cyrus Jahansouz, Martin Freeman, Stuart K. Amateau
Techniques and Innovations in Gastrointestinal Endoscopy.2026; 28(1): 250952. CrossRef

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