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Endoscopic Sphenopalatine Artery Ligation: General Applicability in a Teaching Unit.

Shi Ying Hey1, Nigel K F Koo Ng1, Gerald W McGarry1

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|March 20, 2019
PubMed
Summary

Endoscopic sphenopalatine artery ligation (ESPAL) is effective for severe nosebleeds, with a 92.3% success rate. Trainee-performed ESPAL, with proper training, yields comparable outcomes to consultant-led procedures, ensuring patient safety.

Keywords:
endoscopyepistaxissphenopalatine artery ligation

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Area of Science:

  • Otolaryngology
  • Minimally Invasive Surgery

Background:

  • Refractory epistaxis management often requires endoscopic sphenopalatine artery ligation (ESPAL).
  • ESPAL is a core competency for Ear, Nose, and Throat (ENT) trainees in the UK.
  • Assessing ESPAL efficacy in teaching hospitals is crucial for training standards.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of endoscopic sphenopalatine artery ligation (ESPAL) for epistaxis management.
  • To assess the role of trainee surgeons in performing ESPAL procedures.
  • To analyze factors influencing ESPAL success rates, including operator grade and technique.

Main Methods:

  • Retrospective review of 67 ESPAL procedures for epistaxis from December 2005 to December 2013.
  • Analysis of ligation techniques, operator experience (consultant vs. trainee), and supervision levels.
  • Correlation of outcomes with surgical technique, operator grade, and supervision.

Main Results:

  • Overall ESPAL success rate was 92.3% (60/65 patients), with 5 rebleeds within 30 days.
  • Procedures were performed by consultants (47.7%) and trainees (52.3%), with or without supervision.
  • No significant correlation found between rebleed rates and operator grade, supervision, or ligation technique.

Conclusions:

  • Endoscopic sphenopalatine artery ligation (ESPAL) is a safe and effective treatment for epistaxis, achievable by surgeons of varying experience levels with appropriate training.
  • Trainee-performed ESPAL demonstrates comparable outcomes to consultant-led procedures.
  • Simulation-based training can further enhance ESPAL skills and contribute to continuous professional development.