Publication:

Stent-free Endo-DCR: success of the posterior based mucosal flap technique

Background Endoscopic Dacryocystorhinostomy (Endo-DCR) is an established surgical procedure for nasolacrimal duct obstruction (NLDO). While silicone stenting is frequently employed to maintain ostial patency, concerns regarding associated complications and costs have spurred interest in stent-free techniques. This study evaluates the efficacy of the posterior-based mucosal flap technique for stent-free Endo-DCR.

Methods This prospective observational study was conducted at Nandkumar Singh Chouhan Government Medical College, Khandwa, Madhya Pradesh, between July 2023 and July 2025. One hundred and fifty adult patients (165 eyes) diagnosed with primary acquired NLDO were included after obtaining institutional ethics committee approval and informed consent. All participants underwent stent-free Endo-DCR utilizing the posterior-based mucosal flap technique. Primary outcome measures were anatomical success (patent syringing and endoscopic visualization) and functional success (resolution of epiphora and dacryocystitis) assessed at 1, 3, 6 and 12 months post-operatively. Intraoperative and postoperative complications were also meticulously recorded.

Results The mean age of the cohort was 51.2±11.8 years (range: 23-82 years), with a female preponderance (72.0% females). The overall anatomical success rate was 87.9%  and the functional success rate was 85.5% at 12 months follow-up. Minor postoperative complications, predominantly mild synechiae formation (8.5%), were observed, none of which necessitated surgical revision during the study period. The symptomatic re-obstruction rate requiring revision surgery was 2.4%.

Conclusions The posterior-based mucosal flap technique for stent-free Endo-DCR demonstrates robust anatomical and functional success rates with a low complication profile in the patient population of Madhya Pradesh. This approach offers a safe, effective and potentially more economical alternative to stented DCR, particularly relevant for improving access to care in resource-constrained regions.