Success Rate of External, Endonasal, and Transcanalicular Laser DCR with or without Silicone Stent Intubation for NLD Obstruction: A Network Meta-Analysis of Randomized Controlled Trials

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Evereklioğlu C., Şener H., Polat O. A., Sönmez H. K., Günay Şener A. B., Horozoğlu F.

TOD 57. Ulusal Kongre, Antalya, Türkiye, 8 - 12 Kasım 2023, ss.623

  • Yayın Türü: Bildiri / Özet Bildiri
  • Basıldığı Şehir: Antalya
  • Basıldığı Ülke: Türkiye
  • Sayfa Sayıları: ss.623
  • Erciyes Üniversitesi Adresli: Evet

Özet

BACKGROUND AND AIM:To define and compare the effectiveness of external dacryocystorhinostomy (EX-DCR), endonasal (EN-DCR), and transcanalicular laser-assisted (TL-DCR) with or without silicone stent (S) intubation. METHODS:Studies were retrieved from PubMed, Scopus, and WoS. Frequentist and Bayesian Network meta-analyses were performed and pooled estimations were expressed as risk ratio (RR). We included all original investigations of prospective, randomized controlled trials comparing success rate for any two of the following six surgical procedures: Standard EX-DCR with or without S, cold EN-DCR with or without S, and TL-DCR with or without S. Primary outcome measure was objective success rate. RESULTS:PRISMA flow diagram (Fig.1), network plot (Fig.2), and intervention characteristics are shown in Table1. 32 studies with 3277 cases were included in the quantitative analysis. TL-DCR with S was inferior to EN-DCR with S (RR:1.20; 95%CI:1.05-1.37), EX- DCR with S (RR: 1.17 95%CI:1.05-1.29), EN-DCR without S (RR:1.18; 95%CI:1.03-1.35), and EX-DCR without S (RR:1.15; 95%CI:1.05-1.26). No other statistical difference was found between other surgeries. When we excluded studies with additional interventions (nasal and revision surgery) for sensitivity analysis, 23 studies with 2468 cases were included to analysis. The success rates of TL-DCR with S and EN-DCR without S became similar (RR:1.14 95%CI:0.99-1.30) but there was no change in other outcomes. Similar results were found in frequentist and Bayesian statistics. Surface under the cumulative ranking curve was higher for EN-DCR with S (0.75), whereas it was higher for EX-DCR with S (0.56) after sensitivity analysis. CONCLUSIONS:Between En- and Ex and TC without S procedures, there is no statistical difference. The rank probability showed that EN-DCR with S was a more appropriate surgical option when patients with nasal disease were included, whereas EX-DCR with S was a more appropriate surgical option when patients with nasal disease were excluded from the analysis. Keywords: Bayesian, dacryocystorhinostomy, endoscopic, external,