Polyp Recurrence Still Common After ESS for CRS with Nasal Polyposis

How prevalent is nasal polyp recurrence up to 18 months after endoscopic sinus surgery (ESS) with congruent continuing medical management for chronic rhinosinusitis with nasal polyposis (CRSwNP)?

Bottom line
Although current medical and/or surgical interventions for CRSwNP achieve significant improvement in patient-reported outcome measures, polyp recurrence is still common after ESS, with control of polyps up to 18 months found in approximately 60% to 70% of patients.

Background: Modern CRSwNP treatments to reduce the burden of symptoms and future interventions for patients commonly require multimodality therapy, including ESS followed by continued appropriate medical therapy. Controlling polypoid sinus disease is, in part, measured by endoscopic analysis to guide continued medical therapy and monitor disease progression. Despite standard use of endoscopy exams, inadequate data exist for endoscopic findings of recurrent polyposis following ESS.

Study design: Prospective, multicenter cohort of 363 adult patients undergoing ESS for medically recalcitrant CRSwNP between August 2004 and February 2015. (Postoperative endoscopy examination scores were available for 244 participants, who were followed for an average six months overall; 197 returned for a six-month endoscopy, and 125 and 129 participants returned for 12- and 18-month endoscopy, respectively.)

Setting: Oregon Health and Science University, Portland; Stanford University, Palo Alto, Calif.; Medical University of South Carolina, Charleston; University of Utah, Salt Lake City; University of Calgary, Alberta; Medical College of Wisconsin, Milwaukee.

Synopsis: Mean total endoscopy scores improved at six months, but no significant differences were noted between six and 12 months or 12 and 18 months. A total of 211/244 participants with CRSwNP had either unilateral or bilateral edema at some follow-up period; of those, 164/197 had unilateral or bilateral edema at six-month follow-up endoscopy exams, compared to 102/125 at 12 months and 101/129 at 18 months.

After controlling for enrollment site variation, polyp recurrence was associated with previous ESS history and higher preoperative, bilateral nasal polyposis LK endoscopy scores; only previous ESS history was associated with edema recurrence. A subgroup of 63/244 participants returned for endoscopy examinations at all three follow-ups. Overall, 116/244 participants with CRSwNP had either unilateral or bilateral nasal polyp recurrence at some point during the follow-up period.

Unilateral or bilateral recurrent nasal polyposis prevalence following ESS was 35% at six months, 46% at 12 months, and 41% at 18 months; of those, 27 experienced at least temporary polyp resolution through medical therapy or clinic-based procedures. Limitations include potential selection bias in follow-up prevalence and possible inter-rater or intrarater discordance due to the nature of LK endoscopy scoring.