Sialendoscopy Works Well for Obstructive Salivary Gland Disease: Meta-Analysis

June 24, 2012

NEW YORK (Reuters Health) Jun 21 - Sialendoscopy is safe and effective in obstructive diseases of the salivary glands in adults, according to a meta-analysis this month in Archives of Otolaryngology Head and Neck Surgery.

Lead author Dr. Julie E. Strychowsky from McMaster University, Hamilton, Ontario, Canada and colleagues note by way of background that obstructive sialadenitis accounts for roughly half of benign salivary gland disease. Submandibular gland obstruction accounts for 80% to 90% of cases followed by obstruction of the parotid glands (5%-10%) and sublingual glands (< 1%).

Traditional management is conservative, although refractory cases may require surgery, which can range from papillotomy to complete gland extirpation. Surgical complications following sialadenectomy result in varying amounts of morbidity.

Sialendoscopy offers a minimally invasive approach. "This technique allows endoscopic intraluminal visualization and offers a mechanism to treat diseases of the ductal system, ultimately reducing or eliminating the need for sialadenectomy and obviating related surgical risks," the authors point out.

The "paucity of published data" on sialendoscopy led the researchers to pool data from the literature, to get a better picture of the safety and efficacy of this approach. They searched MEDLINE, EMBASE, and the Cochrane Library through October 2010, identifying and including 29 prospective and retrospective studies of interventional sialendoscopy for salivary gland obstruction in adults.

Outcome measures included success rates (symptom-free and absence of residual obstruction), sialadenectomy, and complications.

Based on the weighted pooled analysis, the success rates were 86% for interventional sialendoscopy alone (1,213 patients) and 93% for sialendoscopy with a combined surgical approach (374 patients).

"Outcomes following interventional sialendoscopy for radioiodine-induced sialadenitis were reported in only three studies and success rates were "variable," they note. "Rates of sialadenectomy were low, and few major complications were reported."

This analysis, they say, provides a summary of the best available evidence and suggests that sialendoscopy is "efficacious, safe, and gland preserving for the treatment of patients with major salivary gland obstructive disease. It is a novel and powerful minimally invasive treatment modality that is relevant to all physicians and surgeons who treat patients with obstructive salivary gland disease."

The authors did not respond to a request for comment.

SOURCE: http://bit.ly/KPJy10

Arch Otolaryngol Head Neck Surg 2012;138:541-547.

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