Evidence to support the clinical and cost effectiveness of self-expanding metallic stents in the alleviation of the symptoms of esophageal cancer is scant.
Therefore, with this background in mind, a randomized trial has been conducted by a group of researchers from 3 university and hospital departments in Glasgow and Edinburgh, Scotland.
The aims of the randomized trial were to evaluate the immediate and medium-term clinical outcomes following palliative intubation, examine patient quality of life, and evaluate costs and benefits from the perspective of the health service.
The research team recruited 50 patients with inoperable esophageal cancer into the study, and randomly assigned them to receive either a metallic stent (n = 25) or plastic endoprosthesis ((n = 25).
| Cost of initial placement:|
- Metallic stent £983
- Plastic stent £296
| British Journal of Surgery |
Patients were then followed up monthly until death.
No significant difference was observed in procedure-related complications or mortality rate between the 2 groups.
There was a trend towards significance in favor of metallic stents with respect to quality of life and survival (median survival 62 versus 107 days for plastic prosthesis and metallic stent respectively).
The cost of the initial placement of metallic stents was significantly higher than that of plastic endoprosthesis (£983 versus £296).
However, after 4 weeks, costs were no longer significant.
The research group concludes that metallic stents may contribute to improved quality of life in patients with esophageal cancer.
Although initially more expensive say the group, this difference does not last beyond 4 weeks.
They end by saying, "A larger trial involving approximately 300 patients would be required to detect a quality of life benefit of the magnitude observed in this trial."