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Endoscopic sinus surgery for type‐2 CRS wNP : an endotype‐based retrospective study

(2019) LARYNGOSCOPE. 129(6). p.1286-1292
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Abstract
Objectives: Nasal polyps are often characterized by type 2 inflammation and disease recurrence. We developed a new surgical technique, referred to as reboot approach, which aims to maximally remove all sinus mucosa and allow healthy re-epithelialization from the preserved nasal mucosa. We here review type 2 endotype chronic rhinosinusitis with nasal polyps (CRSwNP) patients who underwent classical mucosa-sparing endoscopic sinus surgery (ESS) or the reboot approach. Methods: Retrospective case-control study of 50 consecutive CRSwNP patients who underwent endoscopic sinus surgery between 2015 and 2017, either as a classical non-reboot ESS (n = 20); a partial reboot approach removing the mucosa of the ethmoidal, sphenoidal, and maxillary sinuses (n = 18); or a complete reboot approach including Draf III and removal of all frontal sinus mucosa (n = 12). Polyp recurrence over the follow-up period of 2 years served as the primary outcome. Results: All patients demonstrated a type 2 inflammation of the mucosal tissue harvested during surgery. In the classical approach group (n = 20), nine patients relapsed within 2 years (45%); in the partial reboot group, three out of 18 patients (17%) relapsed; and in the full reboot group one out of 12 patients (8%) relapsed. The relapse rates were significantly different between the non-reboot and the reboot groups (P = 0.02) but also between all treatment groups (P = 0.038). Conclusion: Complete removal of diseased mucosa from the paranasal sinuses (reboot approach) significantly reduces the recurrence of nasal polyps for 30 months postoperatively compared to the current mucosa-sparing approach in type 2 inflammatory CRSwNP. Level of Evidence: 3b
Keywords
CRSwNP, nasal polyps, chronic rhinosinusitis, endotypes, FESS, reboot approach, CHRONIC RHINOSINUSITIS EPIDEMIOLOGY, STAPHYLOCOCCUS-AUREUS, NASAL POLYPOSIS, RISK-FACTORS, RECURRENCE, COLONIZATION, PERIOSTIN, OUTCOMES, PATTERN, RATES

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MLA
Alsharif, Saeed, et al. “Endoscopic Sinus Surgery for Type‐2 CRS WNP : An Endotype‐based Retrospective Study.” LARYNGOSCOPE, vol. 129, no. 6, 2019, pp. 1286–92.
APA
Alsharif, S., Jonstam, K., Van Zele, T., Gevaert, P., Holtappels, G., & Bachert, C. (2019). Endoscopic sinus surgery for type‐2 CRS wNP : an endotype‐based retrospective study. LARYNGOSCOPE, 129(6), 1286–1292.
Chicago author-date
Alsharif, Saeed, Karin Jonstam, Thibaut Van Zele, Philippe Gevaert, Gabriële Holtappels, and Claus Bachert. 2019. “Endoscopic Sinus Surgery for Type‐2 CRS WNP : An Endotype‐based Retrospective Study.” LARYNGOSCOPE 129 (6): 1286–92.
Chicago author-date (all authors)
Alsharif, Saeed, Karin Jonstam, Thibaut Van Zele, Philippe Gevaert, Gabriële Holtappels, and Claus Bachert. 2019. “Endoscopic Sinus Surgery for Type‐2 CRS WNP : An Endotype‐based Retrospective Study.” LARYNGOSCOPE 129 (6): 1286–1292.
Vancouver
1.
Alsharif S, Jonstam K, Van Zele T, Gevaert P, Holtappels G, Bachert C. Endoscopic sinus surgery for type‐2 CRS wNP : an endotype‐based retrospective study. LARYNGOSCOPE. 2019;129(6):1286–92.
IEEE
[1]
S. Alsharif, K. Jonstam, T. Van Zele, P. Gevaert, G. Holtappels, and C. Bachert, “Endoscopic sinus surgery for type‐2 CRS wNP : an endotype‐based retrospective study,” LARYNGOSCOPE, vol. 129, no. 6, pp. 1286–1292, 2019.
@article{8629391,
  abstract     = {Objectives: Nasal polyps are often characterized by type 2 inflammation and disease recurrence. We developed a new surgical technique, referred to as reboot approach, which aims to maximally remove all sinus mucosa and allow healthy re-epithelialization from the preserved nasal mucosa. We here review type 2 endotype chronic rhinosinusitis with nasal polyps (CRSwNP) patients who underwent classical mucosa-sparing endoscopic sinus surgery (ESS) or the reboot approach.
Methods: Retrospective case-control study of 50 consecutive CRSwNP patients who underwent endoscopic sinus surgery between 2015 and 2017, either as a classical non-reboot ESS (n = 20); a partial reboot approach removing the mucosa of the ethmoidal, sphenoidal, and maxillary sinuses (n = 18); or a complete reboot approach including Draf III and removal of all frontal sinus mucosa (n = 12). Polyp recurrence over the follow-up period of 2 years served as the primary outcome.
Results: All patients demonstrated a type 2 inflammation of the mucosal tissue harvested during surgery. In the classical approach group (n = 20), nine patients relapsed within 2 years (45%); in the partial reboot group, three out of 18 patients (17%) relapsed; and in the full reboot group one out of 12 patients (8%) relapsed. The relapse rates were significantly different between the non-reboot and the reboot groups (P = 0.02) but also between all treatment groups (P = 0.038).
Conclusion: Complete removal of diseased mucosa from the paranasal sinuses (reboot approach) significantly reduces the recurrence of nasal polyps for 30 months postoperatively compared to the current mucosa-sparing approach in type 2 inflammatory CRSwNP.
Level of Evidence: 3b},
  author       = {Alsharif, Saeed and Jonstam, Karin and Van Zele, Thibaut and Gevaert, Philippe and Holtappels, Gabriële and Bachert, Claus},
  issn         = {0023-852X},
  journal      = {LARYNGOSCOPE},
  keywords     = {CRSwNP,nasal polyps,chronic rhinosinusitis,endotypes,FESS,reboot approach,CHRONIC RHINOSINUSITIS EPIDEMIOLOGY,STAPHYLOCOCCUS-AUREUS,NASAL POLYPOSIS,RISK-FACTORS,RECURRENCE,COLONIZATION,PERIOSTIN,OUTCOMES,PATTERN,RATES},
  language     = {eng},
  number       = {6},
  pages        = {1286--1292},
  title        = {Endoscopic sinus surgery for type‐2 CRS wNP : an endotype‐based retrospective study},
  url          = {http://dx.doi.org/10.1002/lary.27815},
  volume       = {129},
  year         = {2019},
}

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