Steroid-Eluting Stents for Maintaining Frontal Sinus Patency After Endoscopic Sinus Surgery: A Systematic Review and Meta-Analysis

Background Steroid-eluting stents (SES) are used alongside functional endoscopic sinus surgery (FESS) to maintain sinus ostium patency and reduce Scar tissue formation and inflammation. Their effectiveness in minimizing oral steroid use and revision surgeries is debated. This review assesses the efficacy and safety of SES in maintaining patency of the frontal sinus ostium (FSO) and improving postoperative outcomes after endoscopic sinus surgery (ESS). Methods This review followed PRISMA guidelines and searched multiple databases, including PubMed and Web of Science, for studies published up to 2024. It included 6 studies: 4 randomized controlled trials and 2 non-randomized studies. A meta-analysis was conducted using OpenMetaAnalyst to evaluate postoperative outcomes. Results Six studies involving 412 patients from the U.S. and China found that the use of SES was linked to a non-significant trend in reducing the need for postoperative oral steroids (odds ratio: 0.58, 95% CI: 0.25 to 1.32). The pooled proportion of patients needing additional surgery was 6.9% (95% CI: −0.1% to 13.8%, P = .052). The rate of FSO occlusion/restenosis was 15.6% (95% CI: 10.5% to 20.8%, P < .001). SES showed benefit in studies with control groups receiving surgery alone, but no benefit when compared to those receiving large-volume steroid irrigations. Conclusion SES effectively reduce inflammation and restenosis after surgery compared with surgery alone. However, their benefits may be limited to selected patients. Further studies on patient selection and cost-effectiveness will be required to guide future clinical practice.