title: Palliative treatment of advanced esophageal cancer with metal-covered expandable stents. A cost-effectiveness and quality of life study.
abstract: OBJECTIVE
  The aim of this retrospective study was to evaluate the efficacy and safety of endoscopic therapy with self-expanding metallic endoprostheses in the management of inoperable primary malignant esophageal obstruction or stenosis and the cost-effectiveness of the method.
  
  
  METHODS
  Between 5/1997-12/2002, obstruction of the esophagus was diagnosed in 78 patients (52 males, 26 females, age range 53-102, mean 72.3 years). The etiology was squamous cell carcinoma (n=42) and adenocarcinoma of the oesophagus (n=36). In total, 89 ultraflex metal stents were introduced endoscopically. In 46 patients dilation with Savary dilators prior to stent placement was required. A cost-effective analysis was performed, comparing oesophageal stenting with laser therapy.
  
  
  RESULTS
  Stents were placed successfully in all patients. After 48 h, all patients were able to tolerate solid or semi-solid food. During the follow-up period 8 patients developed dysphagia due to food impaction (treated successfully endoscopically). Eleven patients developed recurrent dysphagia 4-16 weeks after stenting due to tumor overgrowth and were treated with placement of a second stent. The median survival time was 18 weeks. There was no survival difference between squamous cell and adenocarcinoma of the esophagus. A similar cost was calculated for both procedures. A significant improvement in quality of life was noted in patients undergoing stenting (96% and 75% vs. 71% and 57% for the first two months).
  
  
  CONCLUSIONS
  Placement of self-expanding metal stents is a safe and cost-effective treatment modality that improves the quality of life, compared with laser therapy, for patients with inoperable malignant esophageal obstruction.
authors.affiliation: Gastroenterology Unit, „Agios Savvas” Cancer Hospital, Athens, Greece.
authors.forename: D
authors.initials: D
authors.lastname: Xinopoulos
authors.forename: D
authors.initials: D
authors.lastname: Dimitroulopoulos
authors.forename: K
authors.initials: K
authors.lastname: Tsamakidis
authors.forename: D
authors.initials: D
authors.lastname: Korkolis
authors.forename: A
authors.initials: A
authors.lastname: Fotopoulou
authors.forename: A
authors.initials: A
authors.lastname: Bazinis
authors.forename: M
authors.initials: M
authors.lastname: Kontis
authors.forename: P
authors.initials: P
authors.lastname: Vasilopoulos
authors.forename: E
authors.initials: E
authors.lastname: Paraskevas