Therapeutic sialendoscopy for the management of radioiodine sialadenitis

Objective: To describe our experience with therapeutic sialendoscopy for radioiodine (iodine 131 [ ¹³¹I]) sialadenitis. Design: Retrospective medical chart review. Setting: Academic tertiary referral center. Patients: The study included 11 patients who underwent therapeutic sialendoscopy for the treatment of ¹³¹I sialadenitis after failing medical management. Interventions: Therapeutic sialendoscopy with dilation and irrigation of the ductal system was performed in all patients. Main Outcome Measures: Patient-reported frequency and severity of symptoms. Results: Our series included 9 women and 2 men (mean age, 51 years; age range, 35-65 years). A total of 23 parotid glands and 5 submandibular glands were treated.Sialendoscopy was possible in all patients, except one in whom the Stensen duct could not be cannulated. Typical endoscopic findings included pale ductal mucosa, thick mucous plugs, ductal debris, and stenosis of the duct. Most patients (91%) reported improvement of symptoms after a single procedure. Complete resolution of symptoms, with sustained benefit, was reported by 6 patients (54%) at a mean follow-up of 18 months. Partial improvement of symptoms, with some persistent intermittent episodes of pain or swelling, was reported by 4 patients (36%). One patient reported no subjective symptomatic improvement after 2 procedures and subsequently underwent a parotidectomy. Conclusions: Sialendoscopy is useful for the improvement of symptoms due to radioiodine-induced sialadenitis in patients who are refractory to conservative medical therapy. Therapeutic sialendoscopy appears to provide effective and sustained symptom improvement in most patients in our experience.