title: Argon plasma coagulation compared with stent placement in the palliative treatment of inoperable oesophageal cancer.
abstract: BACKGROUND
  Self-expandable metal stents (SEMSs) are the main palliative modality used in inoperable oesophageal cancer. Other palliative modalities, including argon plasma coagulation (APC), have also been used.
  
  
  OBJECTIVE
  The purpose of this study was to assess the relative efficacy of SEMS and APC regarding the survival of patients with inoperable oesophageal cancer, not receiving chemo/radiotherapy.
  
  
  METHODS
  Single centre, retrospective analysis of all patients (n= 228) with inoperable oesophageal cancer between January 2000 and July 2014, not receiving chemo-radiotherapy, treated with SEMS (n= 160) or APC (n= 68) as primary palliation modalities. Cox regression analysis was performed to identify individual factors affecting survival and Kaplan-Meier curves were created for patients treated with APC and SEMS for stage III and IV disease. Survival intervals were compared by the log-rank test.
  
  
  RESULTS
  Type of treatment was the only statistically significant factor affecting survival, after disease stage stratification (hazard ratio (HR): 1.36, 95% confidence interval (CI): 1.13-1.65 of SEMS over APC,p: 0.002). Median survival for patients treated with APC and SEMS was 257 (interquartile range (IQR): 414, 124) and 151 (IQR: 241, 61) days respectively in stage III disease. It was 135 (IQR: 238, 43) and 70 (IQR: 148, 32) days respectively in stage IV disease. Both differences were statistically significant (p= 0.02 and 0.05 respectively).
  
  
  CONCLUSIONS
  APC is a promising palliation modality in inoperable oesophageal cancer, when patients are not candidates for chemo-radiotherapy. A randomized controlled trial will be needed to confirm those results.
authors.affiliation: Centre for Liver and Digestive Disorders, University of Edinburgh, Edinburgh, UK.
authors.forename: Dimitrios E
authors.initials: DE
authors.lastname: Sigounas
authors.affiliation: Centre for Liver and Digestive Disorders, University of Edinburgh, Edinburgh, UK.
authors.forename: Christoforos
authors.initials: C
authors.lastname: Krystallis
authors.affiliation: University Department of Surgery, The Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Graeme
authors.initials: G
authors.lastname: Couper
authors.affiliation: University Department of Surgery, The Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Paterson-Brown
authors.affiliation: Medical School, University of Ioannina, Ioannina, Greece.
authors.forename: Athina
authors.initials: A
authors.lastname: Tatsioni
authors.affiliation: Centre for Liver and Digestive Disorders, University of Edinburgh, Edinburgh, UK.
authors.forename: John N
authors.initials: JN
authors.lastname: Plevris
keywords: Argon plasma coagulation; endoscopy; oesophageal cancer; palliation; self-expandable metal stents