Sialendoscopy-Assisted Ductal Irrigation Versus Standard Care in Primary Sjögren’s Syndrome

Summary

This review evaluates sialendoscopy-assisted ductal irrigation as a gland-directed adjunct therapy for xerostomia and recurrent sialadenitis in primary Sjögren’s syndrome. Compared with conservative care, this minimally invasive technique targets ductal obstruction and inflammation, potentially improving salivary flow, relieving symptoms, and restoring glandular function while maintaining an acceptable safety profile.

Abstract

Primary Sjögren’s syndrome (pSS) is a systemic autoimmune disease characterized by lymphocytic infiltration and progressive dysfunction of exocrine glands, leading to xerostomia, xerophthalmia, and recurrent sialadenitis. Conventional management focuses on symptomatic relief with saliva substitutes, oral hygiene, secretagogues, and systemic immunomodulation for extra-glandular disease. However, these approaches do not directly address ductal obstruction, periductal inflammation, or intraductal strictures that contribute to persistent glandular dysfunction. This review critically evaluates the role of sialendoscopy-assisted ductal irrigation compared with standard care in patients with pSS, with emphasis on clinical efficacy, safety, and future research needs. Randomized controlled trials, prospective cohorts, and systematic reviews were prioritized. Representative high-quality sources were examined in full, with data synthesized into comparative tables. Evidence from controlled trials and prospective cohorts indicates that sialendoscopy with ductal dilation and irrigation, often with corticosteroid instillation, improves unstimulated salivary flow, reduces glandular swelling, and alleviates subjective xerostomia more effectively than conservative therapy alone. Safety data suggest the procedure is well tolerated, with transient glandular discomfort and swelling being the most common adverse events. Compared to standard care, sialendoscopy provides unique advantages by directly targeting ductal pathology, though variability in techniques, small sample sizes, and limited long-term data constrain definitive conclusions. Sialendoscopy-assisted ductal irrigation represents a promising adjunctive therapy for managing salivary gland dysfunction in pSS, addressing pathophysiological mechanisms beyond symptomatic relief. While short-term efficacy and safety appear favourable, larger multicenter randomized trials, standardized protocols, and long-term outcome studies are needed to establish its role within evidence-based treatment algorithms.

Introduction

Primary Sjögren’s syndrome (pSS) is a systemic autoimmune disease that predominantly affects women and is characterized by chronic lymphocytic infiltration of exocrine glands, particularly the salivary and lacrimal glands¹. The hallmark clinical manifestations xerostomia (dry mouth) and xerophthalmia (dry eyes) are accompanied by a range of secondary complications such as impaired oral health, dysphagia, dysarthria, dental caries, mucosal infections (notably candidiasis), and substantial impairment of quality of life². Beyond glandular involvement, a subset of patients experiences extraglandular systemic disea....