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Meta-Analysis
. 2014 Oct 30;2014(10):CD005048.
doi: 10.1002/14651858.CD005048.pub4.

Interventions for dysphagia in oesophageal cancer

Yingxue Dai  1 , Chaoying Li, Yao Xie, Xudong Liu, Jianxin Zhang, Jing Zhou, Xiongfei Pan, Shujuan Yang
Affiliations
Meta-Analysis

Interventions for dysphagia in oesophageal cancer

Yingxue Dai et al. Cochrane Database Syst Rev. .

Abstract

Background: Most patients with oesophageal and gastro-oesophageal carcinoma are diagnosed at an advanced stage and require palliative intervention. Although there are many kinds of interventions, the optimal one for the palliation of dysphagia remains unclear. This review updates the previous version published in 2009.

Objectives: The aim of this review was to systematically analyse and summarise the efficacy of different interventions used in the palliation of dysphagia in primary oesophageal and gastro-oesophageal carcinoma.

Search methods: To find new studies for this updated review, in January 2014 we searched, according to the Cochrane Upper Gastrointestinal and Pancreatic Diseases model, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE and CINAHL; and major conference proceedings (up to January 2014).

Selection criteria: Only randomised controlled trials (RCTs) were included in which patients with inoperable or unresectable primary oesophageal cancer underwent palliative treatment. Different interventions like 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, were included. 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.

Data collection and analysis: Data collection and analysis were performed in accordance with the methods of the Cochrane Upper Gastrointestinal and Pancreatic Diseases Review Group.

Main results: We included 3684 patients from 53 studies. SEMS insertion was safer and more effective than plastic tube insertion. Thermal and chemical ablative therapy provided comparable dysphagia palliation but had an increased requirement for re-interventions and for adverse effects. Anti-reflux stents provided comparable dysphagia palliation to conventional metal stents. Some anti-reflux stents might have reduced gastro-oesophageal reflux and complications. Newly-designed double-layered nitinol (Niti-S) stents were preferable due to longer survival time and fewer complications compared to simple Niti-S stents. Brachytherapy might be a suitable alternative to SEMS in providing a survival advantage and possibly a better quality of life, and might provide better results when combined with argon plasma coagulation or external beam radiation therapy.

Authors' conclusions: Self-expanding metal stent insertion is safe, effective and quicker in palliating dysphagia compared to other modalities. However, high-dose intraluminal brachytherapy is a suitable alternative and might provide additional survival benefit with a better quality of life. Some anti-reflux stents and newly-designed stents lead to longer survival and fewer complications compared to conventional stents. Combinations of brachytherapy with self-expanding metal stent insertion or radiotherapy are preferable due to the reduced requirement for re-interventions. Rigid plastic tube insertion, dilatation alone or in combination with other modalities, and chemotherapy alone are not recommended for palliation of dysphagia due to a high incidence of delayed complications and recurrent dysphagia.

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Conflict of interest statement

None

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1: SEMS versus plastic tube (main analysis), Outcome 1: Dysphagia improvement
1.2
1.2. Analysis
Comparison 1: SEMS versus plastic tube (main analysis), Outcome 2: Subgroup analysis dysphagia improvement
1.3
1.3. Analysis
Comparison 1: SEMS versus plastic tube (main analysis), Outcome 3: Persistent or recurrent dysphagia
1.4
1.4. Analysis
Comparison 1: SEMS versus plastic tube (main analysis), Outcome 4: Technical success of procedure
1.5
1.5. Analysis
Comparison 1: SEMS versus plastic tube (main analysis), Outcome 5: Procedure mortality
1.6
1.6. Analysis
Comparison 1: SEMS versus plastic tube (main analysis), Outcome 6: 30‐day mortality
1.7
1.7. Analysis
Comparison 1: SEMS versus plastic tube (main analysis), Outcome 7: Initial hospital stay in mean days
1.8
1.8. Analysis
Comparison 1: SEMS versus plastic tube (main analysis), Outcome 8: All major adverse effects
1.9
1.9. Analysis
Comparison 1: SEMS versus plastic tube (main analysis), Outcome 9: Adverse effects
2.1
2.1. Analysis
Comparison 2: SEMS versus laser, Outcome 1: Persistent or recurrent dysphagia
2.2
2.2. Analysis
Comparison 2: SEMS versus laser, Outcome 2: Interventions for recurrent dysphagia
2.3
2.3. Analysis
Comparison 2: SEMS versus laser, Outcome 3: Adverse effects
2.4
2.4. Analysis
Comparison 2: SEMS versus laser, Outcome 4: Technical success of procedure
2.5
2.5. Analysis
Comparison 2: SEMS versus laser, Outcome 5: Procedure mortality
3.1
3.1. Analysis
Comparison 3: Laser versus plastic tube, Outcome 1: Recurrent dysphagia
3.2
3.2. Analysis
Comparison 3: Laser versus plastic tube, Outcome 2: Adverse effects
3.3
3.3. Analysis
Comparison 3: Laser versus plastic tube, Outcome 3: Technical success of procedure
3.4
3.4. Analysis
Comparison 3: Laser versus plastic tube, Outcome 4: Procedure mortality
3.5
3.5. Analysis
Comparison 3: Laser versus plastic tube, Outcome 5: Dysphagia improvement
3.6
3.6. Analysis
Comparison 3: Laser versus plastic tube, Outcome 6: All adverse effects
4.1
4.1. Analysis
Comparison 4: Laser versus laser plus brachytherapy, Outcome 1: Recurrent dysphagia
4.2
4.2. Analysis
Comparison 4: Laser versus laser plus brachytherapy, Outcome 2: Adverse effects
4.3
4.3. Analysis
Comparison 4: Laser versus laser plus brachytherapy, Outcome 3: 30‐day mortality
4.4
4.4. Analysis
Comparison 4: Laser versus laser plus brachytherapy, Outcome 4: Technical success of procedure
4.5
4.5. Analysis
Comparison 4: Laser versus laser plus brachytherapy, Outcome 5: Procedure Mortality
5.1
5.1. Analysis
Comparison 5: Laser versus photodynamic therapy (PDT), Outcome 1: Dysphagia improvement (2‐point grade or more)
5.2
5.2. Analysis
Comparison 5: Laser versus photodynamic therapy (PDT), Outcome 2: Adverse effects
6.1
6.1. Analysis
Comparison 6: Covered Ultraflex SEMS versus covered Wallstent, Outcome 1: Dysphagia improvement
6.2
6.2. Analysis
Comparison 6: Covered Ultraflex SEMS versus covered Wallstent, Outcome 2: Persistent or recurrent dysphagia
6.3
6.3. Analysis
Comparison 6: Covered Ultraflex SEMS versus covered Wallstent, Outcome 3: Technical success
6.4
6.4. Analysis
Comparison 6: Covered Ultraflex SEMS versus covered Wallstent, Outcome 4: 30‐day mortality
6.5
6.5. Analysis
Comparison 6: Covered Ultraflex SEMS versus covered Wallstent, Outcome 5: All adverse effects
6.6
6.6. Analysis
Comparison 6: Covered Ultraflex SEMS versus covered Wallstent, Outcome 6: Adverse effects
6.7
6.7. Analysis
Comparison 6: Covered Ultraflex SEMS versus covered Wallstent, Outcome 7: Procedure related mortality
7.1
7.1. Analysis
Comparison 7: SEMS versus plastic tube (degree of concealment), Outcome 1: Persistent or recurrent dysphagia (analysis by concealment of allocation)
7.2
7.2. Analysis
Comparison 7: SEMS versus plastic tube (degree of concealment), Outcome 2: Technical success (analysis by concealment of allocation)
7.3
7.3. Analysis
Comparison 7: SEMS versus plastic tube (degree of concealment), Outcome 3: Procedure mortality (analysis by concealment of allocation)
7.4
7.4. Analysis
Comparison 7: SEMS versus plastic tube (degree of concealment), Outcome 4: 30‐day mortality (analysis by concealment of allocation)
7.5
7.5. Analysis
Comparison 7: SEMS versus plastic tube (degree of concealment), Outcome 5: All major side effects (analysis by concealment of allocation)
7.6
7.6. Analysis
Comparison 7: SEMS versus plastic tube (degree of concealment), Outcome 6: Adverse effects (analysis by concealment of allocation A)
7.7
7.7. Analysis
Comparison 7: SEMS versus plastic tube (degree of concealment), Outcome 7: Adverse effects (analysis by concealment of allocation: non‐A)
8.1
8.1. Analysis
Comparison 8: Anti‐reflux versus standard open stent, Outcome 1: Dysphagia improvement
8.2
8.2. Analysis
Comparison 8: Anti‐reflux versus standard open stent, Outcome 2: Quality of life
8.3
8.3. Analysis
Comparison 8: Anti‐reflux versus standard open stent, Outcome 3: Reflux score
8.4
8.4. Analysis
Comparison 8: Anti‐reflux versus standard open stent, Outcome 4: Dyspnea score
8.5
8.5. Analysis
Comparison 8: Anti‐reflux versus standard open stent, Outcome 5: All adverse effects
8.6
8.6. Analysis
Comparison 8: Anti‐reflux versus standard open stent, Outcome 6: Adverse effects
9.1
9.1. Analysis
Comparison 9: Brachytherapy versus brachytherapy plus radiotherapy, Outcome 1: Adverse effects
See this image and copyright information in PMC

Update of

Comment in

References

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References to studies excluded from this review

Airoldi 2003 {published data only}
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Hatlevoll 1992 {published data only}
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Hishikawa 1991 {published data only}
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Homs 2004d {published data only}
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Kolaric 1976 {published data only}
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Kolaric 1980 {published data only}
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Kostopoulos 2003 {published data only}
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Kozarek 1995 {published data only}
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Laasch 2002 {published data only}
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Naveau 1989 {published data only}
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O'Rourke 1992 {published data only}
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Radford 1989 {published data only}
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Rupinski 2000 {unpublished data only}
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Schmassmann 1997 {published data only}
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Schmid 1993 {published data only}
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Sur 2002 {published data only}
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