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Background/Objectives: Chronic and recurrent sialadenitis are inflammatory disorders of the major salivary glands often managed with repeated courses of systemic antibiotics, despite limited long-term efficacy and growing concerns regarding antimicrobial resistance. Minimally invasive intraductal therapies, including sialoendoscopy with irrigation, have emerged as effective alternatives aimed at addressing ductal obstruction and chronic inflammation while reducing antibiotic exposure. This study aimed to systematically review the available evidence on the effectiveness and safety of sialoendoscopy with intraductal irrigation in the management of chronic and recurrent sialadenitis, with particular attention to its potential antibiotic-sparing role. Methods: A literature review was conducted in accordance with PRISMA guidelines. Major scientific databases were searched to identify studies evaluating sialoendoscopy with intraductal irrigation in patients with chronic or recurrent sialadenitis. Study characteristics, patient populations, irrigation protocols, and clinical outcomes were extracted and qualitatively analyzed. Results: Sialoendoscopy with intraductal irrigation was associated with significant clinical improvement in more than two-thirds of patients, with complete or partial symptom resolution. The procedure demonstrated high technical feasibility and a favorable safety profile. Symptom control was maintained across most etiological subgroups. The need for prolonged or repeated systemic antibiotic treatment decreased following endoscopic intervention. Conclusions: Sialoendoscopy with intraductal irrigation may represent a promising and minimally invasive therapeutic option for chronic and recurrent sialadenitis and may contribute to improved antibiotic stewardship by reducing unnecessary systemic antibiotic use. These findings suggest that intraductal therapeutic strategies could be considered within evolving care pathways for chronic salivary gland disorders, aligning clinical management with broader public health efforts to combat antimicrobial resistance.
Manzella et al. (Mon,) studied this question.