(607) Chitosan-Based Dressings After Endoscopic Sinus Surgery: An Updated Meta-Analysis of Human Randomized Trials

Introduction: We conducted an updated systematic review and meta-analysis of randomized controlled trials in humans to determine whether chitosan dressings improve early endoscopic healing outcomes after ESS.

Methods: A comprehensive literature search was conducted across PubMed, Embase, Web of Science, Scopus, and the Cochrane Library. Inclusion criteria consisted of RCTs that assessed the effect of a chitosan dressing following endoscopic sinus surgery. Outcomes included postoperative endoscopic scores for granulation, crusting, and edema. Pooled mean differences (MD) with 95% confidence intervals (CI) were calculated using inverse-variance meta-analysis, with fixed- or random-effects models applied according to heterogeneity.

Results: 161 unique studies were screened after a comprehensive search of five databases. Four randomized controlled trials were included in the final meta-analysis. A total of 268 nasal cavities were included in the meta-analysis. Three studies evaluated granulation, demonstrating no significant difference between chitoan and control groups (MD −0.01, 95% CI −0.14 to 0.11; p = 0.85) with no statistically significant heterogeneity (I² = 0%). Crusting was assessed in four studies, showing no statistically significant reduction with chitosan dressings (MD −0.12, 95% CI −0.51 to 0.26; p = 0.53). However, high heterogeneity was observed in the crusting meta-analysis (I² = 84%). Edema outcomes showed no statistical significance among groups, with high heterogeneity (MD −0.01, 95% CI −0.14 to 0.11; p = 0.85; I² = 0%).

Conclusions: Contrary to the previously published systematic review, which pooled human and animal studies reporting significant benefits of chitosan-based dressings across multiple outcomes, this updated systematic review, including a human-only meta-analysis, found no significant improvement in postoperative granulation, crusting, or mucosal edema following ESS. By restricting inclusion criteria to randomized controlled trials in the human population, the efficacy of chitosan gel dressing may be more limited than previously reported.