Interventional sialendoscopy for radioiodine-induced sialadenitis: quo vadis?

Abstract

La tossicità delle ghiandole salivari rappresenta un noto effetto indesiderato dello iodio radioattivo (I) utilizzato per il trattamento di neoplasie tiroidee, con una prevalenza che varia dal 2% al 67% della popolazione esposta. Recentemente, la scialoendoscopia è stata introdotta come un interessante strumento diagnostico e terapeutico per la gestione dei pazienti affetti da scialoadenite radioiodio-indotta non responsiva ai trattamenti medici standard. L’obiettivo della presente revisione è stato valutare l’influenza di questa procedura sulla storia clinica di pazienti affetti da scialoadenite conseguente a trattamento con radioiodio. Complessivamente, la revisione ha incluso 8 studi, 122 pazienti e 264 scialoendoscopie. Le stenosi duttali ed i tappi mucosi hanno rappresentato l’85.7% dei reperti endoscopici, sostenendo il ruolo dell’ostruzione duttale nella fisiopatologia della scialoadenite da radioiodio. Circa l’89.3% dei pazienti riportarono una risoluzione parziale o completa degli episodi di scialoadenite ricorrente, senza complicanze post-operatorie maggiori. Un solo caso è stato sottoposto a parotidectomia per fallimento del trattamento scialoendoscopico e persistenza dei sintomi. Tuttavia, i risultati della letteratura riguardarono principalmente valutazioni soggettive e solamente in due esperienze cliniche furono prese in considerazione misure oggettive con risultati discordanti. La xerostomia fu analizzata in pochi studi, con benefici differenti rispetto ai sintomi ostruttivi. La tempistica ideale per la videoendoscopia delle ghiandole salivari necessita di ulteriori analisi, al fine di definire la miglior gestione delle scialoadeniti ostruttive radioiodio-indotte.

Management of Chronic Sialadenitis due to Sjogren’s Syndrome and Radioactive Iodine Therapy Using Sialendoscopy

“…Prior publications support its utility in the management of Sjogren's syndrome, with recent studies showing a significant reduction in the frequency of sialadenitis and improved salivary flow, as well as decreased xerostomia in Sjogren's patients managed with sialendoscopy [5][6][7][8]. For the RAI population, the data are similarly limited, with studies showing subjective benefit for medically refractory sialadenitis but equivocal impact on xerostomia [9][10][11][12]. We investigated the use of sialendoscopy to treat sialadenitis due to Sjogren's syndrome and RAI to better understand its indications and efficacy in non-stone disease.…”

Recurrent obstructive salivary disease after sialendoscopy. A narrative literature review

“…The parotid gland is most frequently affected due to a better ability to intake iodine in comparison with the submandibular gland 39 . The subsequent salivary gland obstruction, secondary to parenchymal injuries due to an increased permeability of the gland vascular endothelium with leakage of proteins and electrolytes, is responsible of the fibrotic and stenotic feature of the main Stensen’s duct and its branches; interventional sialendoscopy, mainly based on ductal hydraulic dilation with saline solution plus steroids, and in case of stenosis on ductal balloon dilation, is effective in 89.3% of cases, as reported by a recent review of the literature including 122 patients and 264 sialendoscopic procedures 40 . In this series, complete therapeutic success was achieved in 33.1% of patients, and partial success in 56.2% of patients, with 5.9% of patients requiring multiple procedures.…”

“…The rate of recurrences is similar to that of stones and stenosis, with about 10% of patients having persisting symptoms and recurrent inflammation. In such cases, a cycle of outpatient duct irrigation with steroids can further contribute to silence the inflammatory reaction of the duct system 40 ; moreover, the use of oral steroids may help in controlling the severity of symptoms. To date, none of the patients treated with interventional sialendoscopy plus outpatient steroid duct irrigations had to undergo transcervical sialadenectomy in our long-term clinical experience 4 .…”

Assessment of salivary gland function after 177Lu-PSMA radioligand therapy: Current concepts in imaging and management

“…analyzed data from eight studies to assess the impact of sialendoscopy intervention on outcomes of 122 patients suffering from radioiodine induced sialadenitis. They noted that the intervention helped in resolving duct stenosis and mucus plugs that led to complete or partial resolution of symptoms in approximately 89% of patients [65] . The other treatment options that are currently under investigation include intraglandular gene therapy, down-regulation of key regulators of DNA damage-induced apoptosis (antisense therapy), and stem cell therapy [66] .…”