PROSPECTIVE RANDOMIZED TRIAL OF LASER THERAPY ONLY AND LASER THERAPY FOLLOWED BY ENDOSCOPIC INTUBATION FOR THE PALLIATION OF MALIGNANT DYSPHAGIA

Forty six consecutive patients admitted for the relief of malignant dysphagia were prospectively randomised to receive laser therapy only or initial laser therapy followed by endoscopic intubation. Twenty patients were treated in each group with six exclusions. The patients' swallowing ability was assessed before and during the remainder of their life on a 0-4 scale with 0 being normal swallowing and 4 total dysphagia. The patient's quality of life was measured at the same times, using a physician's assessment (QL index) and the patient's own assessment using a linear analogue self assessment (LASA). There was a significant correlation between all the QL index and the LASA scores collected (n =126; rs = 0.594, p<0.001). The mean monthly dysphagia grade correlated with the QL index (rs = 0.433, p<0.001) and the LASA (rs = 0.272, p<0.002). There was no significant difference in the dysphagia grade before or after treatment in either group. Dysphagia fluctuated more in those treated with the laser only, however, than in those with a tube inserted. There was also no significant difference in the quality of life measured between the two groups of patients. The complication rate (laser only 10%, laser/intubation 40%, p<0.05) was significantly higher in intubated patients. The recurrent dysphagia rate (laser only 25%, laser/ intubation 45%, NS) was higher in patients treated with intubation, but they required fewer endoscopic procedures. Overall both procedures were effective in relieving dysphagia and in maintaining quality of life. There was no procedure related mortality in either group.