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lüll Colonic stent versus surgery for the management of acute malignant colonic obstruction: a decision analysis Siddiqui A; Khandelwal N; Anthony T; Huerta SAliment Pharmacol Ther 2007[Nov]; 26 (10): 1379-86BACKGROUND: Acute colonic obstruction because of advanced colonic malignancy is a surgical emergency. AIM: To compare the clinical outcomes and cost-effectiveness of endoscopic self-expanding metal stent (SEMS) vs. surgery for emergent management of acute malignant colonic obstruction in patients with metastatic colorectal cancer over a 6-month period. METHODS: Decision analysis was used to calculate the cost-effectiveness and success of two competing strategies in a hypothetical patient with metastatic colon cancer presenting with acute, malignant colonic obstruction: (i) emergent colonic stent (SEMS cohort); (ii) emergent surgical resection followed by diversion (surgery cohort). RESULTS: Self-expanding metal stent resulted in a success and a lower mortality rate when compared to surgery over a 6-month period. Colonic SEMS was also associated with a lower mean cost per patient (USD 27,225 vs. USD 57,398). Mortality in the surgery group was 25 times that of the SEMS cohort. One- and two-way sensitivity analyses identified SEMS as the dominant strategy. CONCLUSION: Colonic stent insertion is more effective and less costly than surgery for the management of colonic obstruction in patients with metastatic colon cancer.|Colonic Diseases/economics/mortality/*therapy[MESH]|Colonic Neoplasms/economics/mortality/*therapy[MESH]|Cost-Benefit Analysis/statistics & numerical data[MESH]|Decision Support Techniques[MESH]|Emergencies/economics[MESH]|Female[MESH]|Humans[MESH]|Intestinal Obstruction/economics/mortality/*therapy[MESH]|Male[MESH]|Stents/*economics[MESH]|Survival Rate[MESH] |