BACKGROUND: Both laser therapy and esophageal stenting can relieve dysphagia from esophageal carcinoma, but their effectiveness and the costs associated with each have never been directly compared. AIM: To compare the initial and prolonged effectiveness and costs of laser therapy vs. metal stent placement in a prospective, randomized trial. METHODS: 16 patients with dysphagia due to inoperable, exophytic adeno or squamous cell carcinoma of the esophagus were randomized to receive either Nd:Yag laser therapy or a coated self-expanding metal stent (Wallstent, Schneider, Inc., USA). Initial effectiveness was determined by 1) % of patients achieving relief of dysphagia (either a 2 grade improvement using a 0-4 grade scoring system, or complete relief of dysphagia) and 2) number of therapeutic endoscopies (Tx EGDs) required to achieve this. Prolonged effectiveness was determined by 3) % of patients who did not require reintervention for dysphagia and 4) total number of Tx EGDs required. Costs were Medicare billed charges to patients for Tx EGDs only. RESULTS Effectiveness Laser (n = 7) Stept (n = 9) p value 1. Relief of dysphagia 86% 78% NS 2. Initial Tx EGDs mean ± SD 2.1 ± 0.3 1.0 ± 0.0 <.001 3. No reintervention 28% 91% .001 4. Total Tx EGDs mean (range) 4.2 (2-7)† 1.1(1-2)* <.001 Costs $4810 ± 3264 $2903 ± 871 .05 Mean ± SD Complications: *one patient required a second stent because of stent migration. †Two patients required placement of a stent eventually for extrinsic compression. There was no procedure-related morbidity or mortality. SUMMARY: Based on preliminary data from this prospective trial, expandable metal stents appear to offer comparably effective relief of dysphagia, fewer initial and subsequent therapeutic interventions, and lower overall costs to patients than laser therapy for palliative treatment of esophageal carcinoma. Metal stents provided by Schneider Inc., Minneapolis, MN.
|Original language||English (US)|
|State||Published - 1998|
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