Sialendoscopy: On the Brink of Prime Time in the US?

Patients’ consent forms include the possibility of gland removal should the surgeon be unable to access the gland endoscopically, said Dr. Schaitkin, who also learned sialendoscopy at the ESTC. Dr. Schaitkin and Ricardo L. Carrau, MD, Professor of Otolaryngology at the University of Pittsburgh School of Medicine, have, with Dr. Marchal’s assistance, established an American Sialendoscopy Training Center (ASTC), that aims to train-as did the ESTC-American physicians interested in learning the technique. The next American course will be held November 9, 2008, in Pittsburgh (https://ccehs.upmc.edu/formalCourses.jsp ). The next European course will be held October 9-11, 2008, in Geneva (www.sialendoscopy.com ).

Good for Which Patients?

Patients with suspected sialolithiasis comprise the major population for whom sialendoscopy is indicated. Dr. Marchal has now published a series on treating children with obstructive salivary gland swelling, and has shown that the technique has greater diagnostic sensitivity than conventional radiology, ultrasound, and MRI.⁹ Although larger series with longer-term follow-up are needed to confirm these results, Dr. Marchal believes that the future for this procedure is bright.

In addition, those with stenotic disease, inflammatory conditions (such as Sjögren’s syndrome or recurrent parotitis of childhood), or radioiodine-induced sialadenitis may also be candidates for diagnostic sialendoscopy. Dr. Eisele has observed a therapeutic benefit of doing sialendoscopy in the last group of patients. Dr. Schaitkin reported that at his center, patients with inflammatory conditions are treated primarily with lavage and intraglandular deposition of steroids for localized control of the inflammation.

Dr. Marchal said he exercises extreme caution in cases of infection of the duct. I’ve always said this is a contraindication, because the ductal walls are more fragile when they are inflamed and can be perforated more easily. It’s always delicate to push fluid into an area where there is already an infection; it may push and spread the infection further. In good hands, if you have good experience, this may be all right, but trying to introduce this as standard therapy might be dangerous.

If You Offer It, Will They Come?

Dr. Eisele doubts that sialendoscopy will be hugely applicable in every general otolaryngology practice. The equipment is expensive and, he said, there are relatively small numbers of eligible patients in the United States compared with those in series reported from Europe. The results of 77 patients who underwent sialendoscopy between 2004 and 2007 at UCSF Medical Center were recently reported.⁵ Dr. Eisele and colleague Amol M. Bhatki, MD, reported a 73% success rate of stone removal, with minimal complications. They have now completed 106 procedures in 85 patients since they began to do the procedure in the fall of 2004. I am doing perhaps 30 to 40 procedures a year at this point in time, he said. I think the prevalence of the disorder that is the primary indication for this procedure-sialolithiasis-is less in the United States compared to Europe.