Is nasal closure an effective treatment for severe refractory epistaxis in HHT? A scoping review and narrative synthesis.

Abstract

Introduction: Hereditary haemorrhagic telangiectasia (HHT) is an uncommon genetic disorder characterised by recurrent, severe epistaxis which poses significant management challenges. Nasal closure has emerged as a treatment for refractory cases, however there is limited research on its outcomes. We aim to consolidate existing evidence to assess its efficacy and safety.

Methods: We conducted a systematic search of the Cochrane library, EMBASE, PubMed and non-indexed publications from the past 30 years. Two independent reviewers extracted data and assessed bias from included studies. Findings were summarised via narrative synthesis due to heterogeneity of included studies.

Results: 192 patients from ten studies underwent nasal closure. Frequently used outcome measures were validated epistaxis severity scores, Glasgow Benefit Inventory and haemoglobin trends. Surgery improved quality of life and reduced epistaxis severity post-operatively. Partial dehiscence is a frequently reported complication which is usually successfully treated with revision surgery.

Conclusions: Nasal closure reduces epistaxis severity, improving quality of life in patients with severe, refractory HHT-related epistaxis, providing a valuable treatment option for the most challenging cases. The strength of our conclusions is limited by the heterogeneity of outcome measures. To our knowledge, this is the largest pooled database of patients who have undergone nasal closure.