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Background About half of the patients suffering from malignant pleural effusion (MPE) complain of dyspnea with poor quality of life. Objective The aim of this study was to compare the efficacy and safety of silver nitrate pleurodesis (SNP) via tube thoracostomy and modified indwelling pleural catheter (IPC) in the management of patients complaining of recurrent symptomatic MPE. Patients and methods This two-arm, nonblinded interventional study (randomized controlled trial) was conducted between April 2018 and October 2019. In all, 45 patients were involved in this study and were randomly divided into two groups. Group I (SNP via tube thoracostomy, SNP group) including 21 patients and group II (modified IPC, IPC group) including 24 patients. Findings All enrolled patients had either moderate or massive pleural effusions. The majority of cases (61.9% of the SNP group and 69.6% of the modified IPC group) had successful pleurodesis. Mean hospital stay was significantly lower among the modified IPC group in comparison to the SNP group. The modified IPC group had a significantly higher chest pain score and higher dyspnea score at 1-month postprocedure in comparison to the SNP group. Interpretation SNP via intercostal tube and modified IPC pleurodesis for the management of recurrent symptomatic MPE were nearly equally effective with a high success rate and low tolerable complications. Both methods were safe and inexpensive in the achievement of pleurodesis. Modified IPC pleurodesis had the advantage of a single-day procedure and shorter hospital stay. [ABSTRACT FROM AUTHOR]