Efficacy and Cost Analysis of Sialendoscopy in Cohort of Pediatric Patients With Salivary Gland Disorders

April 19, 2022

A research team from the Department of Otolaryngology at UPMC and the University of Pittsburgh School of Medicine, and the Division of Pediatric Otolaryngology at UPMC Children’s Hospital of Pittsburgh published results from a retrospective analysis of patient outcomes with an accompanying cost analysis of sialendoscopy to diagnose and treat Juvenile Recurrent Parotitis (JRP) and sialolithiasis (SL).

The paper was published in February 2022 in the International Journal of Pediatric Otorhinolaryngology. Amanda L. Stapleton, MD, associate professor of otolaryngology, was the senior author of the study.

“Since its advent, minimally invasive sialendoscopy to diagnose and conservatively treat various salivary gland disorders has shown excellent safety and clinical outcomes in adult patients," says Dr. Stapleton. "However, the literature on the use of sialendoscopy in children and its efficacy is less abundant, partially because it is an uncommon disorder. We have been using this technique at UPMC Children's since 2012 and wanted to better understand our patient outcomes with a secondary goal of elaborating treatment costs and the financial impacts of having one of these disorders.”

Study Details

In this study, Dr. Stapleton and colleagues examined outcomes data in 22 cases of JRP and SL treated at UPMC Children’s with sialendoscopy between 2012 and 2020. JRP was the diagnosis in 18 cases; 4 cases were for SL. The average age of onset in patients treated for JRP was 6.5 years, and for SL, the average age of onset was 14.2 years. All of the patients examined in this study had an average of 4.5 episodes of symptoms that required some form of intervention (e.g., antibiotic regimen) or visited a medical provider for consultation (e.g., ED visit, primary care provider encounter).

While JRP often will resolve itself in time, it can take years to occur. Given the recurrent nature of symptoms and infections, patients with these types of salivary gland disorders need an early intervention that gives them a good chance of avoiding multiple office or ED visits, repeat courses of antibiotics, and the time and costs associated with such frequent care needs. Two or more episodes of facial swelling in a patient should prompt a referral to an ENT specialist, as the literature shows that after two episodes, the likelihood of further recurrence is very high.

“If possible, our goal is to preserve the gland and avoid the need for more invasive procedures, particularly when it comes to the parotid because of the risk of iatrogenic nerve damage during surgery," says Dr. Stapleton. "Sialoendoscopy as a first line intervention is a minimally invasive way to treat these disorders.”

Clinical Highlights and Outcomes

Dr. Stapleton and colleagues' study points toward sialendoscopy for JRP and SL as an effective, minimally invasive first-line approach to treatment, which can achieve complete resolution of symptoms in most patients after 1 or 2 procedures.

“50% of our JRP patients had a complete resolution of symptoms after a single procedure, and of the remaining patients, 80% had a complete resolution of symptoms and recurrent infections after two procedures. All of our SL patients were symptom-free after one or more interventions," says Dr. Stapleton. “

The procedure typically only takes an hour to perform, and it avoids the need for a large incision or open approach. The salivary gland ducts can be explored for signs of obstruction, stenosis, or anatomical anomaly. Dilation of a narrowed duct is possible through the endoscope, as well as the removal of stones if present. Antibiotics and steroids can be placed directly in the ducts to more effectively treat active infection or quell the remnants of old infection or inflammation. Patients undergoing sialendoscopy go home the same day, and children generally return to school and their usual activities within one to two days. There is also generally no need for opioid-type analgesics – acetaminophen or ibuprofen are typically all that is required to manage any post-operative pain effectively.

"We continue to add patient data and long-term follow-up metrics to our studies to build a more robust evidence base supporting early intervention with sialendoscopy for these conditions," says Dr. Stapleton. "We are also interested in learning more about why some cases require more than one intervention to achieve symptom resolution and perhaps be able to predict this trajectory in advance and allow for a more controlled approach to case management."

Comparing Costs of Sialendoscopy to Treat Sialolithiasis and JRP

Beyond the study's clinical effectiveness and outcomes measures, Dr. Stapleton and colleagues also assessed the costs of care for the JRP and SL cohorts. The analysis examined both medical care costs prior during the year prior to sialendoscopy and costs of care in the post-operative period.

"We wanted to better understand pre- and post-operative costs for these patients and compare the two cohorts for any appreciable differences. We also wanted to know the financial variations of performing sialendoscopy for JRP and SL,” says Dr. Stapleton.

Findings from the research showed that operative costs of sialendoscopy to treat patients with SL or JRP were equivalent. However, in both the 1 year before and after the procedure, the mean medical care costs (all costs excluding operative costs) for the JRP cohort were higher than for the SL patients — $4,308.80 versus $3,330. Also of note is that the post-operative 1-year costs of care for the SL patient cohort were substantially lower than the JRP group - $404.20 versus $2,144.

Read more about the study, its design, and additional findings using the reference below.

Learn more about Dr. Stapleton here.

Study Reference

Velasquez N, Gardiner L, Ramprasad V, Shaffer A, Jabbour N, Stapleton A. Cost Analysis of Sialendoscopy for the Treatment of Salivary Gland Disorders in Children. Int J Pediatr Otorhinolaryngol. 2022; 153: 111020.