Table 6 Summary of the evidence for ‘efficacy of systemic steroids before endoscopic sinus surgery in CRSwNP’
Study | Year | LOE (1a to 5) | Study design | Study groups | Clinical endpoints efficacy | Conclusion |
|---|---|---|---|---|---|---|
Ecevit et al. | 2015 | 1b | Prospective double-blind RCT | Adults with CRSwNP with surgical indication receiving either oral prednisolone, 60 mg/day for 7 day, then reduced to 10 mg (1 tablet) taken every other day, stopping on d 17 (n = 11) or placebo (n = 10) | 1. Perioperative bleeding 2. Visibility of the operative field 3. Operative time 4. Hospital stay | Perioperative bleeding, operative time and hospital stay were significantly reduced in patients who received oral steroids. Visibility of the operative field was significantly better after receiving steroids |
Wright et al. | 2007 | 1b | Prospective double-blind RCT | 26 adult CRSwNP patients with surgical indication receiving either 30Â mg of prednisone for 5Â days preoperatively or placebo | 1. Difficulty of surgery 2. Operative time 3. Peroperative blood loss | Surgeons rated the surgery in the placebo-treated group as more difficult than the steroid-treated group No differences were noted in operative duration and blood loss |
Günel et al. | 2015 | 1b | Prospective double-blind RCT | 65 adult CRSwNP patients with surgical indication receiving either oral prednisolone (1 mg/kg for 2 days and then tapered down, with treatment completed on the day 10) or placebo | 1. Intraoperative blood loss 2. Quality of surgical field | No difference in intraoperative blood loos when patients received oral steroids preoperatively Non-significant improvement of quality of surgical field after oral steroids |
Fraire et al. | 2013 | 3b | Prospective non-randomized CT | Adult CRS patients with surgical indication (CRSsNP and CSRwNP) receiving either 2×/day 30 mg methylprednisolone on 5 consecutive days prior to surgery (n = 27) vs. no treatment (n = 27) | 1. Intraoperative bleeding 2. Surgical time 3. Quality of surgical field | Operative bleeding was significantly reduced in CRSwNP patients who received oral steroids preoperatively. No significance obtained in quality of operating field. No difference in surgical time |
Sieskiewicz | 2006 | 1b | RCT | 36 adult CRSwNP patients with surgical indication receiving either prednisone (30Â mg/day for 5 consecutive days directly before the surgery) or no preoperative treatment | 1. Intraoperative bleeding 2. Surgical time 3. Quality of surgical field | Quality of the operating field and surgical time were significantly improved in CRSwNP patients who received oral steroids preoperatively. No significance obtained in total blood loss |