Endoscopic diode laser-cauterization superior for treatment of pyriform sinus fistula
Acute suppurative thyroiditis through the congenital pyriform sinus fistula (PSF) often recurs if the fistula is not resected. Although endoscopic chemo-cauterization (ECC) to obliterate the orifice of the fistula is less invasive than open fistulectomy, it may require repeated treatments. While, the endoscopic diode laser-cauterization (ELC) system may yield superior outcomes and is therefore the optimal treatment modality for pyriform sinus fistula, finds a study recently published in the Journal of Otolaryngology- Head and Neck Surgery.
A team of researchers from the Department of Surgery, Kuma Hospital, Hyogo, Japan recently adopted an endoscopic diode laser-cauterization (ELC) system with the intention of improving treatment outcomes in pyriform sinus fistula. The investigators described endoscopic diode laser-cauterization and compared the outcomes of these three modalities.
The authors evaluated a total of 83 patients with pyriform sinus fistula who underwent treatment at Kuma Hospital, a tertiary thyroid treatment hospital.
Patients who were ineligible for the endoscopic procedures underwent open fistulectomy. Barium swallow studies and computed tomography scan under a trumpet maneuver were performed after treatment to evaluate obliteration or removal of the fistula.
It was found out that in total, 70 of the 81 (86%) patients who underwent barium swallow studies after the first treatment achieved obliteration or removal of the fistula. The success rates for open fistulectomy, endoscopic chemo-cauterization, and endoscopic diode laser-cauterization were 100% (9/9), 83% (49/59), and 100% (13/13), respectively.
Endoscopic chemo-cauterization and endoscopic diode laser-cauterization had significantly shorter operative times and lower blood loss than open fistulectomy. Insufficient opening of the mouth was the major reason for converting endoscopic procedures to open fistulectomy.
As a result, the authors concluded that endoscopic diode laser-cauterization may yield superior outcomes and is therefore the optimal treatment modality for pyriform sinus fistula. However, it is still associated with certain limitations. Thus, treatment selection remains dependent on the shape and size of the pyriform sinus fistula and the mouth opening of the individual patient.
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Masuoka, H., Miyauchi, A., Sasaki, T. et al. Outcomes of endoscopic chemo- and laser-cauterizations and open fistulectomy for pyriform sinus fistula. J of Otolaryngol - Head & Neck Surg 50, 49 (2021). https://doi.org/10.1186/s40463-021-00537-7
