Ethanol Sclerotherapy versus Laparoscopic Surgery in Management of Ovarian Endometrioma; a Randomized Clinical Trial
Archives of Academic Emergency Medicine,
Vol. 10 No. 1 (2022),
1 Dey 2022
,
Page e55
https://doi.org/10.22037/aaem.v10i1.1636
Abstract
Introduction: A variety of therapeutic modalities are available in management of ovarian endometrioma. This study aimed to compare the effects of ethanol sclerotherapy and laparoscopic surgery on disease recurrence and ovarian factors of these patients.
Methods: 70 women with ovarian endometrioma and chronic pelvic pain were randomly divided into two groups. The first group underwent sclerotherapy with a puncture needle (cook) and the second group underwent laparoscopic surgery. Both groups were followed up every three months to investigate the recurrence rate. In this regard, ultrasonography was performed 3 months and 12 months after treatment, and serum anti-Müllerian hormone (AMH) levels were also reassessed 12 weeks after the intervention.
Results: 70 women with the mean age of 31.46 ± 4.71 years, and the mean body mass index (BMI) of 23.12 ± 1.01 were studied. The two groups were similar regarding age (p = 0.770), BMI (p = 0.371), history of gastrointestinal signs (p = 0.794), history of urinary diseases (p = 0.324), dysmenorrhea (p = 0.403), pelvic pain (p = 0.454), dyspareunia (p = 0.448), location of cyst (p = 0.448), and diameter of cyst (p = 0.250). In the laparoscopic group, a significant decrease in anti-Müllerian hormone (AMH) levels was observed after 12 weeks (p < 0.0001), while in the sclerotherapy group, no significant changes were found between pre-and post-operative AMH levels (p = 0.120). Cyst size decreased significantly in both groups three months (p < 0.001) and twelve months (p < 0.0001) after treatment. In the third month, 8 patients in the sclerotherapy group and 13 patients in the laparoscopic group had recurrences, and in the twelfth month, 17 patients in the sclerotherapy group and 15 patients in the laparoscopic group had recurrence of symptoms (p > 0.05).
Conclusions: Although AMH level and mean cyst diameter were significantly lower one year after laparoscopy, recurrence rate of ovarian endometrioma was similar between ethanol sclerotherapy and laparoscopy methods.
- Endometriosis
- Ethanol
- Laparoscopy
- Ovarian Cysts
- Sclerotherapy
How to Cite
References
Bennett GL, Slywotzky CM, Cantera M, Hecht EM. Unusual manifestations and complications of endometriosis—spectrum of imaging findings: pictorial review. AJR Am J Roentgenol. 2010;194(6_supplement):WS34-WS46.
Tanbo T, Fedorcsak P. Endometriosis‐associated infertility: aspects of pathophysiological mechanisms and treatment options. Acta Obstet Gynecol Scand. 2017;96(6):659-67.
Del Frate C, Girometti R, Pittino M, Del Frate G, Bazzocchi M, Zuiani C. Deep retroperitoneal pelvic endometriosis: MR imaging appearance with laparoscopic correlation. Radiographics. 2006;26(6):1705-18.
Koninckx PR, Ussia A, Adamyan L, Wattiez A, Gomel V, Martin DC. Pathogenesis of endometriosis: the genetic/epigenetic theory. Fertil Steril. 2019;111(2):327-40.
Falcone T, Lebovic DI. Clinical management of endometriosis. Obstet Gynecol. 2011;118(3):691-705.
de la Torre MAL, Abrao HM, Fernandes LF, Kho RM, Abrao MS. Ten principles for safe surgical treatment of ovarian endometriosis. J Minim Invasive Gynecol. 2017;24(2):203-4.
Shaltout MF, Maged AM, Elsherbini MM, Zaki SS, Dahab S, Elkomy RO. A randomized controlled trial of a new technique for laparoscopic management of ovarian endometriosis preventing recurrence and keeping ovarian reserve. J Ovarian Res. 2019;12(1):1-8.
Working group of ESGE E, WES, Saridogan E, Becker CM, Feki A, Grimbizis GF, et al. Recommendations for the surgical treatment of endometriosis. Part 1: ovarian endometrioma. Hum Reprod Open. 2017;2017(4):hox016.
Somigliana E, Berlanda N, Benaglia L, Viganò P, Vercellini P, Fedele L. Surgical excision of endometriomas and ovarian reserve: a systematic review on serum antimüllerian hormone level modifications. Fertil Steril. 2012;98(6):1531-8.
Alborzi S, Askary E, Keramati P, Moradi Alamdarloo S, Poordast T, Ashraf MA, et al. Assisted reproductive technique outcomes in patients with endometrioma undergoing sclerotherapy vs laparoscopic cystectomy: Prospective cross‐sectional study. Reprod Med Biol. 2021;20(3):313-20.
Steinl GK, Stewart LA, McManus C, Lee JA, Kuo JH. Ethanol ablation for the treatment of benign thyroid nodules. Am J Surg. 2022;224(1):408-11.
Bagrodia N, Defnet AM, Kandel JJ. Management of lymphatic malformations in children. Curr Opin Pediatr 2015;27(3):356-63.
Dietrich C, Chiorean L, Potthoff A, Ignee A, Cui X, Sparchez Z. Percutaneous sclerotherapy of liver and renal cysts, comments on the EFSUMB guidelines. Z fur Gastroenterol. 2016;54(02):155-66.
Funakoshi H, Shirane S, Toda J. Sclerotherapy using polidocanol foam for a giant splenic cyst. Radiol Case Rep. 2020;15(9):1596-600.
Kim GH, Kim PH, Shin JH, Nam IC, Chu HH, Ko H-K. Ultrasound-guided sclerotherapy for the treatment of ovarian endometrioma: an updated systematic review and meta-analysis. Eur Radiol. 2021;32(3):1726-37.
García-Tejedor A, Castellarnau M, Ponce J, Fernández ME, Burdio F. Ethanol sclerotherapy of ovarian endometrioma: a safe and effective minimal invasive procedure. Preliminary results. Eur J Obstet Gynecol Reprod Biol. 2015;187:25-9.
Melzack R. The short-form McGill pain questionnaire. Pain. 1987;30(2):191-7.
Yazbeck C, Koskas M, Scali SC, Kahn V, Luton D, Madelenat P. How I do... ethanol sclerotherapy for ovarian endometriomas. Gynecol Obstet Fertil. 2012;40(10):620-2.
Garcia-Tejedor A, Martinez-Garcia JM, Candas B, Suarez E, Mañalich L, Gomez M, et al. Ethanol sclerotherapy versus laparoscopic surgery for endometrioma treatment: a prospective, multicenter, cohort pilot study. J Minim Invasive Gynecol. 2020;27(5):1133-40.
Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux P, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. Int J Surg. 2012;10(1):28-55.
Martone S, Troìa L, Marcolongo P, Luisi S. Role of medical treatment of endometriosis. Minerva Obstet Gynecol. 2021;73(3):304-16.
Goldberg JM, Falcone T, Diamond MP. Current controversies in tubal disease, endometriosis, and pelvic adhesion. Fertil Steril 2019;112(3):417-25.
Raffi F, Metwally M, Amer S. The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2012;97(9):3146-54.
Mostaejeran F, Hamoush Z, Rouholamin S. Evaluation of antimullerian hormone levels before and after laparoscopic management of endometriosis. Adv Biomed Res. 2015;4.
Deckers P, Ribeiro SC, Simoes RDS, Miyahara C, Baracat EC. Systematic review and meta-analysis of the effect of bipolar electrocoagulation during laparoscopic ovarian endometrioma stripping on ovarian reserve. Int J Gynaecol Obstet. 2017;140(1):11-7.
Biacchiardi CP, Delle Piane L, Camanni M, Deltetto F, Delpiano EM, Marchino GL, et al. Laparoscopic stripping of endometriomas negatively affects ovarian follicular reserve even if performed by experienced surgeons. Reprod Biomed Online. 2011;23(6):740-6.
Huang L, Chang M-Y, Shiau C-S. Changes in anti-müllerian hormone after ultrasound guided aspiration and ethanol sclerotic therapy of ovarian cyst. Taiwan J Obstet Gynecol. 2021;60(3):509-12.
Noma J, Yoshida N. Efficacy of ethanol sclerotherapy for ovarian endometriomas. Int J Gynaecol Obstet. 2001;72(1):35-9.
Rahmani E, Aflatoonian A, Rahsepar M. Assessing the efficacy of aspiration and ethanol injection in recurrent endometrioma before IVF cycle: A randomized clinical trial. Iran J Reprod Med. 2013;11(3):179-84.
Chang M-Y, Hsieh C-L, Shiau C-S, Chiang R-D, Chan C-H. Ultrasound-guided aspiration and ethanol sclerotherapy (EST) for treatment of cyst recurrence in patients after previous endometriosis surgery: analysis of influencing factors using a decision tree. J Minim Invasive Gynecol. 2013;20(5):595-603.
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