Palliation of inoperable esophageal carcinoma: a prospective randomized trial of laser therapy and stent placement

Radiology. 1997 Feb;202(2):344-8. doi: 10.1148/radiology.202.2.9015054.


Purpose: 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.

Materials and 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%).

Conclusion: 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.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Deglutition Disorders / etiology
  • Deglutition Disorders / therapy
  • Esophageal Neoplasms / complications
  • Esophageal Neoplasms / radiotherapy
  • Esophageal Neoplasms / therapy*
  • Esophagus*
  • Female
  • Humans
  • Laser Therapy*
  • Lasers / adverse effects
  • Male
  • Middle Aged
  • Palliative Care*
  • Prospective Studies
  • Recurrence
  • Retreatment
  • Stents* / adverse effects
  • Treatment Outcome