A Cochrane review [Abstract] 1 included 53 studies with a total of 3 684 subjects. Randomised controlled trials in patients with inoperable or unresectable primary oesophageal cancer who underwent palliative treatment were included. Procedures included were rigid plastic intubation, self-expanding metallic stent (SEMS) insertion, brachytherapy, external beam radiotherapy, chemotherapy, oesophageal bypass surgery, chemical and thermal ablation therapy, either head-to-head or in combination. The primary outcome was dysphagia improvement. Secondary outcomes included recurrent dysphagia, technical success, procedure related mortality, 30-day mortality, adverse effects and quality of life.
SEMS insertion was safer and more effective than plastic tube insertion (SMD of dysphagia grade at four or more weeks post-intervention -0.36 (95% CI -0.63 to -0.09, P = 0.009). Thermal and chemical ablative therapy provided comparable dysphagia palliation but had an increased requirement for re-interventions and adverse effects. Anti-reflux stents provided comparable dysphagia palliation to conventional metal stents. Brachytherapy was be a suitable alternative to SEMS in providing a survival advantage and possibly a better quality of life.
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