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Evolution in Endoscopic Sinus Surgery: The Adjuvant Role of Reboot Surgery in Patients with Uncontrolled Nasal Symptoms of Eosinophilic Granulomatosis with Polyangiitis

Purpose: In the era of precision medicine, target-therapy with monoclonal antibodies (mAb) has enabled new treatment options in patients affected by eosinophilic granulomatosis with polyangiitis (EGPA). Nevertheless, sometimes unsatisfactory results at a nasal level may be observed. The aim of this...

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Autores principales: Pirola, Francesca, Giunta, Gianmarco, Muci, Giovanna, Giombi, Francesco, Nappi, Emanuele, Grizzi, Fabio, Heffler, Enrico, Paoletti, Giovanni, Canonica, Giorgio Walter, Mercante, Giuseppe, Spriano, Giuseppe, Schroeder, Jan Walter, Malvezzi, Luca
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10143226/
https://www.ncbi.nlm.nih.gov/pubmed/37109033
http://dx.doi.org/10.3390/jpm13040647
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author Pirola, Francesca
Giunta, Gianmarco
Muci, Giovanna
Giombi, Francesco
Nappi, Emanuele
Grizzi, Fabio
Heffler, Enrico
Paoletti, Giovanni
Canonica, Giorgio Walter
Mercante, Giuseppe
Spriano, Giuseppe
Schroeder, Jan Walter
Malvezzi, Luca
author_facet Pirola, Francesca
Giunta, Gianmarco
Muci, Giovanna
Giombi, Francesco
Nappi, Emanuele
Grizzi, Fabio
Heffler, Enrico
Paoletti, Giovanni
Canonica, Giorgio Walter
Mercante, Giuseppe
Spriano, Giuseppe
Schroeder, Jan Walter
Malvezzi, Luca
author_sort Pirola, Francesca
collection PubMed
description Purpose: In the era of precision medicine, target-therapy with monoclonal antibodies (mAb) has enabled new treatment options in patients affected by eosinophilic granulomatosis with polyangiitis (EGPA). Nevertheless, sometimes unsatisfactory results at a nasal level may be observed. The aim of this study is to describe reboot surgery as a potential adjuvant strategy in multi-operated, yet uncontrolled EGPA patients treated with Mepolizumab. Methods: We performed reboot surgery on EGPA patients with refractory CRSwNP. We obtained clinical data, nasal endoscopy, nasal biopsy, and symptom severity scores two months before surgery and 12 months after it. Computed tomography (CT) prior to surgery was also obtained. Results: Two patients were included in the study. Baseline sinonasal disease was severe. Systemic EGPA manifestations were under control, and the patients received previous mepolizumab treatment and previous surgery with no permanent benefits on sinonasal symptoms. Twelve months after surgery, nasal symptoms were markedly improved; endoscopy showed an absence of nasal polyps and there were fewer eosinophils at histology. Conclusions: We presented the first experience of two EGPA patients with refractory CRSwNP who underwent non-mucosa sparing (reboot) sinus surgery; our results support the possible adjuvant role of reboot surgery in this particular subset of patients.
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spelling pubmed-101432262023-04-29 Evolution in Endoscopic Sinus Surgery: The Adjuvant Role of Reboot Surgery in Patients with Uncontrolled Nasal Symptoms of Eosinophilic Granulomatosis with Polyangiitis Pirola, Francesca Giunta, Gianmarco Muci, Giovanna Giombi, Francesco Nappi, Emanuele Grizzi, Fabio Heffler, Enrico Paoletti, Giovanni Canonica, Giorgio Walter Mercante, Giuseppe Spriano, Giuseppe Schroeder, Jan Walter Malvezzi, Luca J Pers Med Communication Purpose: In the era of precision medicine, target-therapy with monoclonal antibodies (mAb) has enabled new treatment options in patients affected by eosinophilic granulomatosis with polyangiitis (EGPA). Nevertheless, sometimes unsatisfactory results at a nasal level may be observed. The aim of this study is to describe reboot surgery as a potential adjuvant strategy in multi-operated, yet uncontrolled EGPA patients treated with Mepolizumab. Methods: We performed reboot surgery on EGPA patients with refractory CRSwNP. We obtained clinical data, nasal endoscopy, nasal biopsy, and symptom severity scores two months before surgery and 12 months after it. Computed tomography (CT) prior to surgery was also obtained. Results: Two patients were included in the study. Baseline sinonasal disease was severe. Systemic EGPA manifestations were under control, and the patients received previous mepolizumab treatment and previous surgery with no permanent benefits on sinonasal symptoms. Twelve months after surgery, nasal symptoms were markedly improved; endoscopy showed an absence of nasal polyps and there were fewer eosinophils at histology. Conclusions: We presented the first experience of two EGPA patients with refractory CRSwNP who underwent non-mucosa sparing (reboot) sinus surgery; our results support the possible adjuvant role of reboot surgery in this particular subset of patients. MDPI 2023-04-09 /pmc/articles/PMC10143226/ /pubmed/37109033 http://dx.doi.org/10.3390/jpm13040647 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Communication
Pirola, Francesca
Giunta, Gianmarco
Muci, Giovanna
Giombi, Francesco
Nappi, Emanuele
Grizzi, Fabio
Heffler, Enrico
Paoletti, Giovanni
Canonica, Giorgio Walter
Mercante, Giuseppe
Spriano, Giuseppe
Schroeder, Jan Walter
Malvezzi, Luca
Evolution in Endoscopic Sinus Surgery: The Adjuvant Role of Reboot Surgery in Patients with Uncontrolled Nasal Symptoms of Eosinophilic Granulomatosis with Polyangiitis
title Evolution in Endoscopic Sinus Surgery: The Adjuvant Role of Reboot Surgery in Patients with Uncontrolled Nasal Symptoms of Eosinophilic Granulomatosis with Polyangiitis
title_full Evolution in Endoscopic Sinus Surgery: The Adjuvant Role of Reboot Surgery in Patients with Uncontrolled Nasal Symptoms of Eosinophilic Granulomatosis with Polyangiitis
title_fullStr Evolution in Endoscopic Sinus Surgery: The Adjuvant Role of Reboot Surgery in Patients with Uncontrolled Nasal Symptoms of Eosinophilic Granulomatosis with Polyangiitis
title_full_unstemmed Evolution in Endoscopic Sinus Surgery: The Adjuvant Role of Reboot Surgery in Patients with Uncontrolled Nasal Symptoms of Eosinophilic Granulomatosis with Polyangiitis
title_short Evolution in Endoscopic Sinus Surgery: The Adjuvant Role of Reboot Surgery in Patients with Uncontrolled Nasal Symptoms of Eosinophilic Granulomatosis with Polyangiitis
title_sort evolution in endoscopic sinus surgery: the adjuvant role of reboot surgery in patients with uncontrolled nasal symptoms of eosinophilic granulomatosis with polyangiitis
topic Communication
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10143226/
https://www.ncbi.nlm.nih.gov/pubmed/37109033
http://dx.doi.org/10.3390/jpm13040647
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