Interventional procedure overview of corticosteroid-releasing bioabsorbable stent or spacer insertion during endoscopic sinus surgery for chronic rhinosinusitis

Existing assessments of this procedure

A state of the art systematic review by Calvo-Henriquez et al. (2024) posed 9 research questions and concluded that although several questions remain unanswered, there is 'no doubt' that SES will have a place in the day-to-day treatment of CRS. It did not include steroid-impregnated resorbable materials because they are not FDA approved and the amount of drug released into the sinus is not standardised. It concluded that there is ample evidence that SESs improve surgical healing in both ethmoidectomy and frontal sinus surgery but more evidence is needed on whether they improve symptom control after ESS. It also concluded that the SESs appear to be safe but more randomised controlled clinical trials are needed to draw firm conclusions.

The 'International consensus statement on allergy and rhinology: rhinosinusitis 2021' (Orlandi 2020) has the following recommendations:

'Value Judgments: Corticosteroid-eluting stents have been demonstrated to have beneficial impact on postoperative healing although 1 study showed that Merocel in a finger cot had superior healing with less middle meatal adhesions. One study has shown steroid eluting stents to be cost-effective in preventing additional postoperative interventions. Specific usage should be at the clinician's discretion taking into consideration various important patient-specific factors.

Policy Level: While the authors recognize the high cost of these implants, given the level of evidence, absorbable steroid-eluting implants are recommended in carefully selected patients that are similar to those included in the underlying clinical trials.

Intervention: Corticosteroid-eluting stents can be considered in the postoperative ethmoidectomy cavity.'