Abstract

Chronic rhinosinusitis with nasal polyps (CRSwNP) management remains controversial regarding the optimal timing and choice between biological therapies and endoscopic sinus surgery (ESS). This umbrella review aimed to synthesize and compare the effectiveness of these interventions through a systematic evaluation of existing evidence. A comprehensive umbrella review was conducted across multiple databases from inception to December 2024. Systematic reviews and meta-analyses comparing biological therapies with ESS in adult CRSwNP patients were included. Study quality was assessed using AMSTAR-2 criteria. Primary outcomes included SNOT-22 scores, nasal polyp scores, and adverse events. Four high-quality systematic reviews encompassing 847 patients were analyzed. ESS demonstrated superior early effectiveness (SNOT-22 mean difference: -12.4 points, 95% CI: -15.8 to -9.0, p

Key words: Chronic rhinosinusitis, nasal polyps, biological therapy, endoscopic sinus surgery, dupilumab, systematic review