Does Steroid-eluting Stents Improves Post-operative Outcomes in Chronic Rhinosinusitis Patients Undergoing Endoscopic Sinus Surgery? An Updated Systematic Review and Meta-analysis of Randomised Controlled Trials
Authors: Aldokhail Laila Salah , Alawdah Ahmed Mohammed , Alsarar Abdullah Ali , Alotaibi Reem Awahdhallah , Hushayyish Mohammed Hamad Al , Alghamdi Ghaday Fahad , Miftah Feras Omar , Alawad Fatema Hani , Alqahtani Manar Ibraheem S. , Aldanyowi Saud Nayef , Alarfaj Abdullah Ahmed 
Published: December 2024

Abstract

Background:
Chronic rhinosinusitis (CRS), affecting 5%–12% of the global population, significantly decreases the quality of life and causes economic burdens. Endoscopic sinus surgery (ESS) serves as a primary intervention for CRS unresponsive to medical treatment. However, the post-operative phase is full of challenges, including recurrent inflammation and the need for further interventions. Steroid-eluting stents (SES), designed for direct corticosteroid delivery to the inflamed mucosa, represent an innovative approach to minimise the post-operative complications and improve patient outcomes.

Aim:
This meta-analysis aims to evaluate the efficacy and safety of SES in enhancing post-operative outcomes for CRS patients undergoing ESS.

Methods:
Following Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, this study conducted a systematic review and meta-analysis of clinical randomised trials assessing SES effectiveness in CRS management post-ESS. Comprehensive literature searches were performed across PubMed, Scopus, Web of Science and Cochrane library databases, leading to the inclusion of 14 randomised controlled trials (RCTs). Data extraction and quality assessment utilised the risk of bias 2 tool, with statistical analysis conducted using RevMan 5.3 software.

Results:
In total, 14 RCTs involving 1734 patients were analysed. The findings revealed that SES significantly reduced the need for post-operative interventions (odds ratio [OR] = 0.36, 95% confidence interval [CI]: 0.29–0.44, P < 0.00001), the need for additional surgeries (OR = 0.29, 95% CI: 0.19–0.46, P < 0.00001) and the need for post-operative oral steroids (OR = 0.58, 95% CI: 0.41–0.81, P = 0.001). Moreover, SES usage was associated with a decrease in severe adhesions (OR = 0.24, 95% CI: 0.12–0.50, P = 0.0001), middle turbinate lateralisation (OR = 0.28, 95% CI: 0.11–0.74, P = 0.01) and polyp formation (OR = 0.33, 95% CI: 0.24–0.45, P < 0.00001), with an improvement in frontal sinus ostia patency (OR = 2.42, 95% CI: 1.70–3.46, P < 0.00001). However, post-ESS SNOT-22 scores showed no significant improvement (mean difference = −1.10, 95% CI: −5.11–2.92, P = 0.59).

Conclusion:
SES significantly improves the post-operative outcomes for CRS patients undergoing ESS by reducing the need for further interventions and reducing complications. These results underscore the potential of SES to enhance sinus health and patient quality of life post-ESS. However, the lack of significant improvement in post-ESS SNOT-22 scores calls for further research to explore the long-term outcomes and impact on patient-reported symptom relief and quality of life.