Authors' objectives: The medical questions in this assessment focus on the sialendoscopy technique (endoscopy of the major salivary ducts: parotid and submandibular gland in order for it to be refunded by National Health Insurance. They have been grouped into three main topics: • the ability of the technique to diagnose a non-neoplastic condition causing salivary obstruction; • its ability to treat obstructive-type salivary conditions with a favourable benefit-risk balance by improving patient management; • the conditions for performing this procedure.

Authors' recommendations: Currently, due to the low level of evidence from identified studies (n=38), literature analysis does not enable a formal conclusion to be drawn on the diagnostic performance or the efficacy and safety of the procedure regardless of the obstructive indication concerned (sialolithiasis, stenoses, sialadenitis and inflammatory or systemic sialodochitis). These are non-comparative studies, mainly series of retrospective cases with short patient follow-up and heterogeneity of the types of conditions treated and the technical methods used (interventional sialendoscopy with retrieval devices, intraductal fragmentation with laser fibres, combined surgical approach with endoscopic guidance). It should be noted that very often, the technique has the advantage of diagnosis confirmation and treatment during the same procedure. The reported complication rates are relatively low. The position of the working group consulted during this assessment is that sialendoscopy has improved treatment of salivary duct obstructions in children and adults and provided answers for the diagnosis of obstructions not caused by sialolithiasis. It has reduced salivary gland excisions, mainly the number of parotidectomy surgeries, a procedure which carries a high risk of nerve damage. However, the lack of reliable data on the efficacy and safety of this procedure is recognised and the difficulty performing this procedure is emphasised. This led the working group to release recommendations about the use of this technique. They focus on its placein the diagnostic process proposing it is performed after a complete inconclusive assessment with imaging techniques, starting with an ultrasound, and on the specific training required for the healthcare professionals involved. The experts believe that its contribution in terms of treatment is major, mainly for sialolithiasis. They confirm that there are less data with stenoses, the cause of which is extremely variable (trauma, inflammation, systemic), and that the efficacy of the technique is not consistent, but they emphasise that no other conservative treatment technique is currently validated. Sialendoscopy cannot be performed during the acute infectious phase of the condition. Preferably, the indicated procedure should be performed in an operating room to guarantee pain management, patient monitoring and sterile conditions under which to perform this endoscopic technique.

Project Status: Completed

Year Published: 2015

URL for published report: http://www.has-sante.fr/portail/upload/docs/application/pdf/2015-05/texte_court_sialendoscopie.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: France

Organisation Name: Haute Autorité de Santé

Contact Address: 2 avenue du Stade de France, 93218 Saint-Denis La Plaine Cedex, France. Tel: +33 01 55 93 71 88; Fax: +33 01 55 93 74 35;

Contact Name: has.seap.secretariat@has-sante.fr

Contact Email: has.seap.secretariat@has-sante.fr