Authors' objectives:

To provide a systematic review of the clinical effectiveness of endoscopic sinus surgery (ESS) for the removal of nasal polyps.

Authors' results and conclusions: Thirty-three studies were included, three RCTs, three non-RCTs and 27 case series studies. The RCTs and controlled trials reported overall symptomatic improvement that ranged from 78 to 88% for functional endoscopic sinus surgery (FESS) compared with 43 to 84% for comparative techniques (including polypectomy, CaldwellLuc and intranasal ethmoidectomy). Disease recurrence was 8% for FESS compared with 14% for CaldwellLuc and polyp recurrence was 28% for endoscopic ethmoidectomy compared with 35% for polypectomy. Revision surgery was reported in one study only and was the same for FESS and CaldwellLuc procedures. Percentage of overall complications was reported in only one comparative study and was 1.4% for FESS compared with 0.8% for conventional procedures. The case series studies reported overall symptomatic improvement for patients with nasal polyps ranging from 37 to 99% (median 89%). For the mixed patient groups (with and without polypoid disease) overall symptomatic improvement ranged from 40 to 98% (median 88%). Total complications in the case series studies ranged from 22.4 to 0.3% (median 6%).

Authors' recommendations: We have identified large amounts of data on FESS. The majority of studies report that peoples symptoms improve following FESS with relatively few complications; however, only a small proportion of evidence is comparative. Results from non-comparative studies do not inform the choices that need to be made by ear, nose and throat (ENT) surgeons and commissioners. Health economics data are also lacking and therefore cannot inform these decisions. FESS may offer some advantages in effectiveness over comparator techniques, but there is enormous variation in the range of results reported and there are severe methodological limitations. There is a clear need for quality-controlled trials in order to answer questions regarding the effectiveness of FESS. We have identified and presented a number of priority research questions from a selection of ENT surgeons within the UK.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.hta.ac.uk/1308

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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