Endoscopic vs. External Dacryocystorhinostomy in Granulomatosis with Polyangiitis: A Scoping Review of the Literature and Our Experience with Endoscopic Dacryocystorhinostomy

TL;DR

This study compares endoscopic and external DCR surgeries for GPA patients with blocked tear ducts, finding endoscopic DCR to be equally or more effective with fewer complications.

Contribution

The paper provides the first direct comparison of endoscopic and external DCR outcomes in granulomatosis with polyangiitis patients.

Findings

Endoscopic DCR had a 100% success rate in six studies with 22 procedures.

External DCR had an 88.5% success rate in nine studies with 122 procedures.

Endoscopic DCR was associated with lower complications and equivalent or better success rates.

Abstract

Background/Objectives: Although endoscopic dacryocystorhinostomy (DCR) has been widely accepted as the procedure of choice for nasolacrimal duct obstruction (NLDO) management due to most etiologies, concerns regarding the reactivation of disease and involvement of surrounding structures add to hesitation in its utilization for granulomatosis with polyangiitis (GPA) patients. No study has directly compared outcomes of external vs. endoscopic DCR in GPA patients. This information can be helpful for patient counselling and choosing a personalized surgical approach for the best results. Methods: A scoping review of the literature was performed in January 2024. The following databases were searched using a combination of MeSH (Medical Subject Headings) and keywords: Ovid MEDLINE, Ovid EMBASE, Scopus, and Web of Science. This scoping review is not registered. Medical records of two GPA patients who underwent endoscopic DCR at our center were reviewed. Results: The search yielded 96 articles; 15 articles met the inclusion criteria for a full review. Six studies with 22 procedures reported 100% success with endoscopic DCR. Nine studies with 122 procedures reported success in 88.5% of cases with external DCRs. Additional perioperative immunosuppression was recommended in patients with severe mucosal inflammation. The case series presents the disease course, details of surgery, and perioperative management in two GPA patients with NLDO who underwent endoscopic DCR successfully. Conclusions: Endoscopic DCR was associated with equivalent or better success rates and lower complications compared to external DCR in GPA patients. Ensuring disease remission state and appropriate immunomodulatory therapy can help prevent the proposed risk of endonasal disease reactivation with endoscopic DCR.

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