No Effect of Preoperative Mepolizumab on Early Postoperative Healing After ESS for Severe CRSwNP

ABSTRACT Objective To evaluate postoperative endoscopic mucosal healing 2 weeks after ESS in patients with severe CRSwNP treated with surgery alone versus surgery combined with biologics initiated 2 weeks preoperatively. Methods In this exploratory post hoc analysis, patients with severe CRSwNP were divided into two cohorts: ESS alone and ESS with preoperative mepolizumab initiated 2 weeks prior to surgery. Postoperative endoscopic video recordings obtained 2 weeks after ESS were anonymized and evaluated by four raters using blinded offline scoring. Healing was assessed using structured endoscopic domains (including discharge, edema, and scarring) and an overall endoscopic visual analogue scale (VAS 0–10). Inter‐rater reliability was assessed. Results The overall endoscopic VAS score did not differ between groups. Consistent with this, no differences were observed in endoscopic scores. Inter‐rater agreement was moderate for VAS, discharge, and edema, and low for scarring, reflecting inherent limitations of early postoperative endoscopic assessment. Conclusion In this exploratory analysis, preoperative mepolizumab was not associated with measurable differences in early postoperative endoscopic mucosal healing 2 weeks after ESS. These findings relate specifically to early postoperative mucosal appearance and should not be interpreted as evidence regarding the broader efficacy of biologic therapy or longer‐term postoperative outcomes. Larger prospective studies with longer follow‐up are warranted. Level of Evidence 2.