(1240) Use of Topical Furosemide to Reduce Nasal Polyp Relapse and Intraoperative Bleeding: A Systematic Review

Introduction: Preventing recurrent nasal polyposis (NP) post-endoscopic sinus surgery (ESS) is challenging. Intranasal corticosteroids are a primary focus for NP treatment. Several studies suggest using topical intranasal furosemide to prevent poly relapse and reduce intraoperative bleeding (IOB) during polypectomy. However, limited research on its efficacy leaves its role uncertain. This study aims to evaluate the role of topical furosemide (TP) in decreasing nasal polyps relapse (NPR) and IOB during polypectomy.

Methods: A systematic review was conducted in accordance with PRISMA guidelines for studies evaluating the use of TF with either NPR post-ESS or IOB during ESS. Clinical studies published between 1995 and 2023 were identified through the PubMed, EMBASE, and Web of Science databases. We included comparative observational studies but excluded animal studies, case reports, case series and studies in other languages.

Results: A total of 122 abstracts were independently screened by two investigators, 8 articles were identified for full-text review with 7 studies meeting the criteria for qualitative analysis. Four prospective studies using TF after ESS showed a significant reduction in NPR compared to control or intranasal corticosteroid groups, with more than half of the studies reporting reduced NPR (p=0.013, p=0.01, p=0.02). One study found nasal TF spray significantly reduced bleeding and surgery time during ESS, while improving the surgical field quality compared to a control group (p < 0.001). Two studies compared TF and oral steroids for preoperative management of NP. One showed both treatments significantly reduced subjective nasal symptoms and polyp scores (p < 0.001), while the other found no significant improvement in bleeding and operation time.

Conclusions: Available evidence suggests that topical furosemide is safe for the prevention of NPR after ESS, with or without intranasal corticosteroids and its use was associated with reduced amount of bleeding during ESS with improved the quality of the surgical field.