Palliation of inoperable esophageal carcinoma: a prospective randomized trial of laser therapy and stent placement.
OBJECTIVE
A prospective, randomized comparison of the result of endoscopic laser therapy and that of placement of self-expandable metallic endoprostheses was performed to determine which method provides the best palliation of dysphagia in patients with inoperable esophageal carcinoma.


METHODS
Sixty patients participated in the study. Twenty-three were randomly assigned to undergo plastic-covered stent placement, 19 to undergo uncovered stent placement, and 18 to undergo laser therapy. The quality of swallowing was assessed with the dysphagia score, which ranged from 0 for normal swallowing to 4 for complete dysphagia.


RESULTS
The mean improvement in dysphagia score was 2 and ranged from -1 to 3 in patients who underwent placement of plastic-covered stents, was 2 and ranged from 0 to 4 in those who underwent placement of uncovered stents, and was 1 and ranged from 0 to 2 in those who underwent laser therapy. Six of 23 (26%) plastic-covered stents migrated, whereas none of the uncovered stents did so (P < .02). Tumor ingrowth through uncovered stents occurred in five of 19 patients (26%).


CONCLUSIONS
Placement of metallic esophageal endoprostheses is substantially better than endoscopic laser therapy for palliation of dysphagia in patients with inoperable esophageal carcinoma. Use of uncovered and plastic-covered metallic stents provides equal palliation in patients with dysphagia.
Adam
A
A
Department of Radiology, United Medical School of Guy's Hospital, London, England.
Ellul
J
J
Watkinson
A F
AF
Tan
B S
BS
Morgan
R A
RA
Saunders
M P
MP
Mason
R C
RC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy; D004938:Esophageal Neoplasms / Q000150:complications / Q000532:radiotherapy / Q000628:therapy*; D004947:Esophagus; D005260:Female; D006801:Humans; D053685:Laser Therapy; D007834:Lasers / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011446:Prospective Studies; D012008:Recurrence; D019233:Retreatment; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome