ENTtoday

Sialendoscopy: On the Brink of Prime Time in the US?

by Gretchen Henkel •

However, Dr. Marchal-who sees more than five new cases a week at his center-believes that there is a reservoir of patients in the United States as well as in Europe, and that the use of the technique here could follow a similar trajectory to the one he has observed in Switzerland. The larger numbers of cases in Europe are more a function of the procedure’s longer track record and greater availability than to a greater incidence of salivary stones, he believes. Epidemiological analyses done by his center and other researchers have not established causative links between diet and/or water hardness and incidence of sialolithiasis. For instance, he said, We could not find any difference in calcium absorption-due to ingestion of dairy products in Switzerland-and people having stones.

Dr. Marchal has concluded that the success of sialendoscopy in Europe is due to concerted and ongoing reporting of studies as well as education-of his colleagues, the general public, and referring physicians. This pathology is widely underestimated, because the reservoir of patients is kept by the GP, he said. It is those physicians, he said, who warn their patients against surgery because of the history of complications following the older treatments of gland excision.

The real truth is that when you start showing people there is a treatment for something for which there was no noninvasive treatment, patients start to appear, he asserted.

Whether or not the European experience will be duplicated here, Dr. Eisele said that its minimally invasive nature means that sialendoscopy will increasingly offer real benefits to patients. It does require a little more sophisticated equipment-and time-but I think it’s well worth it, he said. Dr. Schaitkin agreed: There’s no doubt in my mind that for stones it’s amazing-for stones, it’s a home run!

References

  1. Marchal F, Dulguerov P, Lehmann W. Interventional sialendoscopy. N Engl J Med 1999;341:1242-3.
  2. Marchal F, Dulguerov P, Becker M, Lehmann W. How I do it: interventional sialendoscopy. Laryngoscope 2000;110(2 Pt 1):318-20.
  3. Marchal F, Dulguerov P. Sialolithiasis management: the state of the art. Arch Otolaryngol Head Neck Surg 2003;129:951-6.
  4. Becker M, Marchal F, Becker C, Dulguerov P, Georgeakopoulos G, Lehmann W, Terrier F. Sialolithiasis and salivary ductal stenosis: diagnostic accuracy of MR sialography with a three-dimensional extended-phase conjugate-symmetry rapid spin-echo sequence. Radiology 2000;217(2):347-58.
  5. Bhatki AM, Eisele DW. Diagnostic and therapeutic sialoendoscopy [sic] in the treatment of obstructive salivary gland disorders. Presentation, Western Section, Triological Society annual meeting, 2007.
  6. Gundlach P, Hopf J, Linnarz M. Introduction of a new diagnostic procedure: salivary duct endoscopy (sialendoscopy) clinical evaluation of sialendoscopy, sialography, and X-ray imaging. Endosc Surg Allied Technol 1994;2(6):294-6.
  7. Marchal F. A combined endoscopic and external approach for extraction of large stones with preservation of parotid and submandibular glands. Laryngoscope 2007;117 (2):373-7.
  8. Chossegros C, Guyot L, Richard O, Barki G, Marchal F. A technical improvement in sialendoscopy to enter the salivary ducts. Laryngoscope 2006;116(5):842-4. (IF:1.51).
  9. Faure F, Froehlich P, Marchal F. Paediatric sialendoscopy. Curr Opin Otolaryngol Head Neck Surg 2008;16(1):60-3.

©2008 The Triological Society