Can the use of steroid eluting stents play a positive role in treating post-surgery recurrent nasal polyposis in the clinic?
Explore this issue:July 2014
Background: Treatment options for recurrent nasal polyps after sinus surgery include medication (primarily steroids) and surgery for symptomatic medical failure patients. Taking medical therapy a step further, a study using a biodegradable eluting device with mometasone was created to determine the drug’s ability to decrease obstructive polyps in post-surgical patients. Safety, efficacy, and feasibility were evaluated in this prospective study.
Study design: Prospective multicenter study (manufacturer sponsored).
Setting: Multicenter study, including academic and private practice research sites in Montreal, Canada; Salt Lake City, Utah; Louisville, Ky.; Fresno, Calif; Colorado Springs, Colo.
Synopsis: Twelve patients with recurrent polyps who had not responded to topical steroids and had a history of endoscopic sinus surgery (ESS) more than 90 days prior to the study onset were included. Additional criteria were failed oral steroid use within six months prior to enrollment and a history of repeated oral steroid use. Patients were not enrolled unless they were free of oral steroid and topical steroid use two weeks prior to the study start. Nasal or oral steroid use was restricted for 90 days following the implant’s insertion. The implants were successfully inserted in 21 of 24 ethmoid sinuses with no serious adverse effect. Within one month, polyps were reduced by at least 50% and remained so for six months. Additionally, mean SNOT scores improved within one month with significance and remained so for six months. A total of 64% of patients were no longer revision ESS candidates at six months.
Bottom line: The use of steroid-eluting implants for recurrent nasal polyps after ESS is a safe, straightforwardly performed clinical procedure, with good results for up to six months post-insertion. In patients with obstructive post-surgical polyps requiring possible revision surgery, it appears that steroid-eluting stents may have value.
However, despite its rigor, this study is problematic in that only 12 patients are included. Also, what happens to these patients after six months? Even more importantly, the study does not address the cost of the eluting stents, which are $700 per side. In most cases, eluting stents are not covered by insurance, and their use can become a financial burden for patients. Further, nasal polyps and associated chronic rhinosinusitis are lifelong problems. Are these stents meant to be used over and over again? If so, compared with other methods of treatment, stent use may not be cost effective.