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Marcellin L, Bourdon M, Houdre D, Maignien C, Chardonnet AG, Borghese B, Mantelet LM, Santulli P, Chapron C. Decrease of dysmenorrhoea with hormonal treatment is a marker of endometriosis severity. Reprod Biomed Online 2023; 46:856-864. [PMID: 36959070 DOI: 10.1016/j.rbmo.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/27/2022] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
RESEARCH QUESTION Is a decrease in dysmenorrhoea after suppressive hormonal therapy a marker of the endometriosis phenotype and of greater disease severity? DESIGN Retrospective observational cohort study conducted in a French university hospital, between January 2004 and December 2019. Non-pregnant women aged younger than 42 years, who tested for dysmenorrhoea relief after suppressive hormonal therapy before surgery, and who had histological confirmation of endometriosis, were included. The comparisons were carried out according to the results of the suppressive hormonal test. RESULTS Of the 578 histologically proven endometriosis patients with preoperative pain symptoms, the rate of dysmenorrhoea decrease after suppressive hormonal therapy was 88.2% (n = 510). These patients had a higher incidence of deep infiltrating endometriosis (DIE) intestinal lesions (45.7% [233/510] versus 30.8% [21/68], P = 0.01) and an increased rate of multiple DIE lesions (two or more) (72.8% [287/394] versus 56.4% [22/39], P = 0.02). After multivariate analysis, decrease of dysmenorrhoea after suppressive hormonal therapy remained significantly associated with the severe DIE phenotype (adjusted OR 3.9, 95% CI 2.0 to 7.6, P < 0.001). CONCLUSION In women with endometriosis, a decrease of dysmenorrhoea after suppressive hormonal therapy is associated with the DIE phenotype and is a marker of greater severity.
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Affiliation(s)
- Louis Marcellin
- Université Paris Cité, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, 75014, Paris, France; Department 'Development, Reproduction and Cancer', Institut Cochin, INSERM U1016, Paris, France.
| | - Mathilde Bourdon
- Université Paris Cité, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, 75014, Paris, France; Department 'Development, Reproduction and Cancer', Institut Cochin, INSERM U1016, Paris, France
| | - Doriane Houdre
- Université Paris Cité, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, 75014, Paris, France
| | - Chloe Maignien
- Université Paris Cité, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, 75014, Paris, France; Department 'Development, Reproduction and Cancer', Institut Cochin, INSERM U1016, Paris, France
| | - Antoine Gaudet Chardonnet
- Université Paris Cité, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, 75014, Paris, France
| | - Bruno Borghese
- Université Paris Cité, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, 75014, Paris, France; Department 'Development, Reproduction and Cancer', Institut Cochin, INSERM U1016, Paris, France
| | - Lorraine Maitrot Mantelet
- Université Paris Cité, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, 75014, Paris, France
| | - Pietro Santulli
- Université Paris Cité, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, 75014, Paris, France; Department 'Development, Reproduction and Cancer', Institut Cochin, INSERM U1016, Paris, France
| | - Charles Chapron
- Université Paris Cité, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, 75014, Paris, France; Department 'Development, Reproduction and Cancer', Institut Cochin, INSERM U1016, Paris, France
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Wójcik M, Szczepaniak R, Placek K. Physiotherapy Management in Endometriosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192316148. [PMID: 36498220 PMCID: PMC9740037 DOI: 10.3390/ijerph192316148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/25/2022] [Accepted: 11/30/2022] [Indexed: 05/13/2023]
Abstract
Endometriosis is a disease whose underlying cause is the growth of the endometrium outside the uterine cavity. The disease is characterised by unpleasant pain in the pelvic region, irrespective of the phase of the woman's cycle. Physiotherapy in its various forms can be an excellent complement to the gynaecological treatment of endometriosis, by virtue of reducing inflammation, alleviating pain and thus significantly improving women's quality of life. Physiotherapy in endometriosis should include kinesiotherapy, manual therapy including visceral therapy, physical therapy, spa treatment including balneotherapy, and hydrotherapy. The aim of this study is to present the use of physiotherapy as an adjunct therapy in the treatment of endometriosis. A review of the available literature in the Medline, PubMed and Google Scholar databases was performed without being limited by the time frame of available publications on the forms of physiotherapy used in the treatment of endometriosis.
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Affiliation(s)
- Małgorzata Wójcik
- Department of Physiotherapy, Faculty of Physical Culture in Gorzow Wielkopolski, Poznan University of Physical Education, 61-871 Poznan, Poland
- Correspondence:
| | - Renata Szczepaniak
- Pabianice Medical Center, Department of Physiotherapy, WSB University, 41-300 Dabrowa Gornicza, Poland
| | - Katarzyna Placek
- Clinic and Department of Obstetrics, Women’s Diseases and Oncological Gynecology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, University Hospital No. 2 Jana Biziela in Bydgoszcz, 85-067 Bydgoszcz, Poland
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3
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Gozdziewicz T, Jarzabek-Bielecka G, Luwanski D, Wojcik M, Plagens-Rotman K, Mizgier M, Pisarska-Krawczyk M, Kedzia W. The Role of Visceral Therapy in the Sexual Health of Women with Endometriosis during the COVID-19 Pandemic: A Literature Review. J Clin Med 2022; 11:jcm11195825. [PMID: 36233690 PMCID: PMC9573042 DOI: 10.3390/jcm11195825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/18/2022] [Accepted: 09/27/2022] [Indexed: 02/07/2023] Open
Abstract
Patients with endometriosis had limited possibilities for contemporary diagnosis and treatment during the SARS-CoV-2 (COVID-19) pandemic. Surgeries that may have eliminated pain or restored fertility were postponed. Endometriosis may affect the vagina, peritoneum, bladder, or other organs outside the pelvis and impact women's sexual health, especially during pandemics. Holistic care of patients is crucial to improving their lives and sexual health. A scoping review was conducted to analyze the relevant literature in light of our experience in gynecology and physiotherapy during the COVID-19 pandemic.
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Affiliation(s)
- Tomasz Gozdziewicz
- Division of Gynecology, Department of Perinatology and Gynecology, Poznan University of Medical Sciences, 61-758 Poznan, Poland
- Correspondence:
| | - Grazyna Jarzabek-Bielecka
- Division of Gynecology, Department of Perinatology and Gynecology, Poznan University of Medical Sciences, 61-758 Poznan, Poland
- Center for Sexology and Pediatric, Adolescent Gynecology, Division of Gynecology, Department of Perinatology and Gynecology, Poznan University of Medical Sciences, 61-758 Poznan, Poland
| | - Dawid Luwanski
- Center for Sexology and Pediatric, Adolescent Gynecology, Division of Gynecology, Department of Perinatology and Gynecology, Poznan University of Medical Sciences, 61-758 Poznan, Poland
| | - Malgorzata Wojcik
- Department of Physiotherapy, Faculty of Physical Culture in Gorzów Wielkopolski, Poznań University of Physical Education, 61-871 Poznan, Poland
| | - Katarzyna Plagens-Rotman
- Center for Sexology and Pediatric, Adolescent Gynecology, Division of Gynecology, Department of Perinatology and Gynecology, Poznan University of Medical Sciences, 61-758 Poznan, Poland
| | - Malgorzata Mizgier
- Department of Sports Dietetics, Poznan University of Physical Education, 61-871 Poznan, Poland
| | - Magdalena Pisarska-Krawczyk
- Center for Sexology and Pediatric, Adolescent Gynecology, Division of Gynecology, Department of Perinatology and Gynecology, Poznan University of Medical Sciences, 61-758 Poznan, Poland
| | - Witold Kedzia
- Division of Gynecology, Department of Perinatology and Gynecology, Poznan University of Medical Sciences, 61-758 Poznan, Poland
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Buggio L, Dridi D, Barbara G, Merli CEE, Cetera GE, Vercellini P. Novel pharmacological therapies for the treatment of endometriosis. Expert Rev Clin Pharmacol 2022; 15:1039-1052. [PMID: 36000243 DOI: 10.1080/17512433.2022.2117155] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Endometriosis is a chronic, estrogen-dependent, inflammatory disease associated with pelvic pain, infertility, impaired sexual function, and psychological suffering. Therefore, tailored patient management appears of primary importance to address specific issues and identify the appropriate treatment for each woman. Over the years, abundant research has been carried out with the objective to find new therapeutic approaches for this multifaceted disease. AREAS COVERED This narrative review aims to present the latest advances in the pharmacological management of endometriosis. In particular, the potential role of GnRH antagonists, selective progesterone receptor modulators (SPRMs), and selective estrogen receptors modulators (SERMs) will be discussed. We performed a literature search in PubMed and Embase, and selected the best quality evidence, giving preference to the most recent and definitive original articles and reviews. EXPERT OPINION Medical therapy represents the cornerstone of endometriosis management, although few advances have been made in the last decade. Most studies have focused on the evaluation of the efficacy and safety of GnRH antagonists (plus add-back therapy in cases of prolonged treatment), which should be used as second-line treatment options in selected cases (i.e. non-responders to first-line treatments). Further studies are needed to identify the ideal treatment for women with endometriosis.
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Affiliation(s)
- Laura Buggio
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12, 20122 Milan, Italy
| | - Dhouha Dridi
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12, 20122 Milan, Italy
| | - Giussy Barbara
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12, 20122 Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi, Milan, Italy
| | - C E E Merli
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12, 20122 Milan, Italy
| | - Giulia Emily Cetera
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12, 20122 Milan, Italy
| | - Paolo Vercellini
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12, 20122 Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi, Milan, Italy
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Vannuccini S, Clemenza S, Rossi M, Petraglia F. Hormonal treatments for endometriosis: The endocrine background. Rev Endocr Metab Disord 2022; 23:333-355. [PMID: 34405378 PMCID: PMC9156507 DOI: 10.1007/s11154-021-09666-w] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 12/25/2022]
Abstract
Endometriosis is a benign uterine disorder characterized by menstrual pain and infertility, deeply affecting women's health. It is a chronic disease and requires a long term management. Hormonal drugs are currently the most used for the medical treatment and are based on the endocrine pathogenetic aspects. Estrogen-dependency and progesterone-resistance are the key events which cause the ectopic implantation of endometrial cells, decreasing apoptosis and increasing oxidative stress, inflammation and neuroangiogenesis. Endometriotic cells express AMH, TGF-related growth factors (inhibin, activin, follistatin) CRH and stress related peptides. Endocrine and inflammatory changes explain pain and infertility, and the systemic comorbidities described in these patients, such as autoimmune (thyroiditis, arthritis, allergies), inflammatory (gastrointestinal/urinary diseases) and mental health disorders.The hormonal treatment of endometriosis aims to block of menstruation through an inhibition of hypothalamus-pituitary-ovary axis or by causing a pseudodecidualization with consequent amenorrhea, impairing the progression of endometriotic implants. GnRH agonists and antagonists are effective on endometriosis by acting on pituitary-ovarian function. Progestins are mostly used for long term treatments (dienogest, NETA, MPA) and act on multiple sites of action. Combined oral contraceptives are also used for reducing endometriosis symptoms by inhibiting ovarian function. Clinical trials are currently going on selective progesterone receptor modulators, selective estrogen receptor modulators and aromatase inhibitors. Nowadays, all these hormonal drugs are considered the first-line treatment for women with endometriosis to improve their symptoms, to postpone surgery or to prevent post-surgical disease recurrence. This review aims to provide a comprehensive state-of-the-art on the current and future hormonal treatments for endometriosis, exploring the endocrine background of the disease.
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Affiliation(s)
- Silvia Vannuccini
- Obstetrics and Gynecology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Sara Clemenza
- Obstetrics and Gynecology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Margherita Rossi
- Obstetrics and Gynecology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Felice Petraglia
- Obstetrics and Gynecology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy.
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Murakami M, Osuka S, Muraoka A, Hayashi S, Bayasula, Kasahara Y, Sonehara R, Hariyama Y, Shinjo K, Tanaka H, Miyake N, Yoshita S, Nakanishi N, Nakamura T, Goto M, Kajiyama H. Effectiveness of NLRP3 Inhibitor as a Non-Hormonal Treatment for ovarian endometriosis. Reprod Biol Endocrinol 2022; 20:58. [PMID: 35351143 PMCID: PMC8966161 DOI: 10.1186/s12958-022-00924-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/03/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Endometriosis is a complex syndrome characterized by an estrogen-dependent chronic inflammatory process that affects 10% of women of reproductive age. Ovarian endometriosis (OE) is the most common lesion in endometriosis and may cause infertility, in addition to dysmenorrhea. Hormonal treatments, which are the conventional treatment methods for endometriosis, suppress ovulation and hence are not compatible with fertility. The inflammasome is a complex that includes Nod-like receptor (NLR) family proteins, which sense pathogen-associated molecular patterns and homeostasis-altering molecular processes. It has been reported that the nucleotide-binding oligomerization domain, leucine-rich repeat, and pyrin domain-containing (NLRP) 3 inflammasome, which contributes to the activation of interleukin-1 beta (IL-1β), might be related to the progression of endometriosis. Therefore, the aim of the present study was to evaluate non-hormonal therapies for OE, such as inhibitors of the NLRP3 inflammasome. METHODS The expression of NLRP3 was measured in the eutopic endometrium (EM) of patients with and without endometriosis and OE samples, as well as stromal cells derived from the endometrium of patients with and without endometriosis and OE samples (endometrial stromal cells with endometriosis [ESCs] and cyst-derived stromal cells [CSCs]). The effects of an NLRP3 inhibitor (MCC950) on ESCs and CSCs survival and IL-1β production were evaluated. We then administered MCC950 to a murine model of OE to evaluate its effects on OE lesions and ovarian function. RESULTS NLRP3 gene and protein expression levels were higher in OE and CSCs than in EM and ESCs, respectively. MCC950 treatment significantly reduced the survival of CSCs, but not that of ESCs. Moreover, MCC950 treatment reduced the co-localization of NLRP3 and IL-1β in CSCs, as well as IL-1β concentrations in CSCs supernatants. In the murine model, MCC950 treatment reduced OE lesion size compared to phosphate-buffered saline treatment (89 ± 15 vs. 49 ± 9.3 mm3 per ovary; P < 0.05). In the MCC950-treated group, IL-1β and Ki67 levels in the OE-associated epithelia were reduced along with the oxidative stress markers of granulosa cells. CONCLUSIONS These results indicated that NLRP3/IL-1β is involved in the pathogenesis of endometriosis and that NLRP3 inhibitors may be useful for suppressing OE and improving the function of ovaries with endometriosis.
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Affiliation(s)
- Mayuko Murakami
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Satoko Osuka
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Ayako Muraoka
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Shotaro Hayashi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Bayasula
- Bell Research Center for Reproductive Health and Cancer, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yukiyo Kasahara
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Reina Sonehara
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yumi Hariyama
- Department of Obstetrics and Gynecology, Toyota Kosei Hospital, Toyota, Aichi, Japan
| | - Kanako Shinjo
- Department of Obstetrics and Gynecology, Toyota Kosei Hospital, Toyota, Aichi, Japan
| | - Hideaki Tanaka
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Natsuki Miyake
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Sayako Yoshita
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Natsuki Nakanishi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Tomoko Nakamura
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Maki Goto
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
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Behbehani S, Suárez-Salvador E, Yi J, Buras M, Kosiorek H, Magrina J. Pregnancy Rates After Surgical Resection of Deep Infiltrating Endometriosis in Patients with Infertility: A Systematic Review and Meta-Analysis. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sadikah Behbehani
- Department of Gynecological Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
- Department of Obstetrics and Gynecology, University of California, Riverside, California, USA
| | - Elena Suárez-Salvador
- Department of Gynecological Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
- Hospital Valle de Hebron of the Universidad Autonoma Barcelona, Barcelona, Spain
| | - Johnny Yi
- Department of Gynecological Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Matthew Buras
- Department of Health Sciences Research, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Heidi Kosiorek
- Department of Health Sciences Research, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Javier Magrina
- Department of Gynecological Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
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Near-Infrared Fluorescence Imaging for the Intraoperative Detection of Endometriosis: A Pilot Study. Life (Basel) 2021; 12:life12010015. [PMID: 35054408 PMCID: PMC8779744 DOI: 10.3390/life12010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: Endometriosis surgery is associated with a high risk of reoperation due to an insufficient recognition of endometriotic lesions. Our aim was to explore the role of near-infrared fluorescence (NIRF) imaging for the visualization and identification of endometriotic lesions next to conventional white light (WL) laparoscopy. Materials and methods: Fifteen women scheduled for diagnostic laparoscopy in whom peritoneal endometriosis was suspected were included. Peritoneal exploration was performed in WL, followed by NIRF imaging after ICG administration. Biopsies of all the suspected lesions were taken for histological examination. Subjective evaluations of the equipment and NIRF imaging were also performed. Results: Only 61% (44) of the biopsied lesions contained endometriosis. The positive predictive value (PPV) for the lesions found in WL was 64%. The PPV for the lesions found under NIRF was 69% and the PPV for the lesions found in both modes was 61%. The mean satisfaction of surgeons regarding the surgical procedure and equipment using both imaging modalities was 6.5 (p > 0.05) on a 10 item Likert scale and the mean satisfaction with the quality of the NIRF imaging was 7.4 (p > 0.05). Conclusion: In this study, the additional value of NIRF imaging, although feasible, was found to be limited for the intraoperative detection of endometriotic lesions.
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Santulli P, Bourdon M, Koutchinsky S, Maignien C, Marcellin L, Maitrot-Mantelet L, Pocate Cheriet K, Patrat C, Chapron C. Fertility preservation for patients affected by endometriosis should ideally be carried out before surgery. Reprod Biomed Online 2021; 43:853-863. [PMID: 34649771 DOI: 10.1016/j.rbmo.2021.08.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 12/20/2022]
Abstract
RESEARCH QUESTION What prognostic factors relate to a high oocyte yield in fertility preservation for women affected by endometriosis? DESIGN Observational cohort study conducted in a tertiary care university hospital between April 2015 and January 2019. Women who had undergone fertility preservation with ovarian stimulation for oocytes and embryo vitrification for endometriosis were included. Prognostic factors associated with the number of oocytes retrieved after the first ovarian stimulation were analysed. RESULTS A total of 146 women who had undergone 258 ovarian stimulation cycles were included; 82 (56.2%) had undergone more than one ovarian stimulation cycle; 72.6% had at least one endometrioma lesion; and 36.3% had previously undergone surgery for endometriosis. After adjustment by multiple linear regression, the factors that significantly reduced the number of oocytes retrieved were previous history of surgery for ovarian endometriosis (coefficient -1.08; 95% CI -2.02 to -0.15; P = 0.024); women's age (-0.21; 95% CI -0.41 to -0.01; P = 0.039); and total dose of gonadotrophin used (-0.01; 95% CI -0.01 to -0.00; P = 0.047). Anti-Müllerian hormone serum level and gravidity positively correlated with an increase in the number of oocytes retrieved (1.65; 95% CI 1.13 to 2.17; P < 0.001 and 3.30; 95% CI 0.91 to 5.68; P = 0.007, respectively) after the first ovarian stimulation cycle. CONCLUSION A history of surgery for ovarian endometriosis was associated with significantly lower oocyte yields. Fertility preservation should be integrated into endometriosis management. Fertility preservation should ideally be made available to the patient before surgery.
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Affiliation(s)
- Pietro Santulli
- Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin - Bâtiment Port Royal, 123 Boulevard de Port-Royal 75679 Paris 14, France; Université de Paris, Department 'Infection, Immunity, Inflammation', INSERM U1016, Institut Cochin, Paris, France.
| | - Mathilde Bourdon
- Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin - Bâtiment Port Royal, 123 Boulevard de Port-Royal 75679 Paris 14, France; Université de Paris, Department 'Infection, Immunity, Inflammation', INSERM U1016, Institut Cochin, Paris, France
| | - Sonia Koutchinsky
- Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin - Bâtiment Port Royal, 123 Boulevard de Port-Royal 75679 Paris 14, France
| | - Chloé Maignien
- Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin - Bâtiment Port Royal, 123 Boulevard de Port-Royal 75679 Paris 14, France
| | - Louis Marcellin
- Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin - Bâtiment Port Royal, 123 Boulevard de Port-Royal 75679 Paris 14, France; Université de Paris, Department 'Infection, Immunity, Inflammation', INSERM U1016, Institut Cochin, Paris, France
| | - Lorraine Maitrot-Mantelet
- Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin - Bâtiment Port Royal, 123 Boulevard de Port-Royal 75679 Paris 14, France
| | - Khaled Pocate Cheriet
- Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Université de Paris, Department 'Infection, Immunity, Inflammation', INSERM U1016, Institut Cochin, Paris, France; Service d'Histologie-Embryologie-Biologie de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, Paris 75014, France
| | - Catherine Patrat
- Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Service d'Histologie-Embryologie-Biologie de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, Paris 75014, France
| | - Charles Chapron
- Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin - Bâtiment Port Royal, 123 Boulevard de Port-Royal 75679 Paris 14, France; Université de Paris, Department 'Infection, Immunity, Inflammation', INSERM U1016, Institut Cochin, Paris, France
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Treatment patterns in women seeking care for endometriosis at an endometriosis center. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2021. [DOI: 10.1177/22840265211045606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To determine the clinical characteristics and prior medical and surgical treatments in women undergoing surgical excision of endometriosis for pelvic pain at a single institution. Methods: In this retrospective cohort study we identified 140 women with pathology-proven endometriosis who completed a preoperative standardized pain form and underwent surgery at an endometriosis center. Women were stratified into three groups for analysis: no prior surgery, 1 prior surgery, and 2+ prior surgeries. Results: The most common treatments used prior to seeking care were hormonal contraceptives (51.6%) and surgery (46.1%). More than half of women were diagnosed with pelvic floor dysfunction at time of presentation or prior to consultation. There was a significant relationship between an increasing number of surgeries (none vs 1 vs 2+) and gonadotropin-releasing hormone (GnRH) agonist use (19.0% vs 27.5% vs 56.0%, p = 0.003). Though not significant, a trend was noted between increasing surgeries and opioid use (20.6% vs 30.0% vs 40.0%, p = 0.17). There was a statistically significant relationship between multiple surgeries and illicit drug use ( p < 0.001). Conclusion: Patients with pelvic pain and endometriosis who have undergone multiple surgeries are more likely to have used GnRH agonists and report illicit drug use prior to presenting to specialized care.
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Ros C, Rius M, Abrao MS, deGuirior C, Martínez-Zamora MÁ, Gracia M, Carmona F. Bowel preparation prior to transvaginal ultrasound improves detection of rectosigmoid deep infiltrating endometriosis and is well tolerated: prospective study of women with suspected endometriosis without surgical criteria. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:335-341. [PMID: 32349172 DOI: 10.1002/uog.22058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/21/2020] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To analyze the effect of bowel preparation prior to transvaginal ultrasound (TVS) examination on the detection of bowel involvement and the description of rectosigmoid nodules of deep infiltrating endometriosis (DIE), and to evaluate patient tolerance of bowel preparation. METHODS This was a prospective study of paired data obtained between September 2015 and March 2016 from a cohort of women referred, on suspicion of DIE but without surgical criteria, to the endometriosis unit of a tertiary university hospital. In all patients, the wall of the rectum and lower sigmoid colon was evaluated by two TVS examinations: the first was performed without bowel preparation and the second was done after the patient had followed a 3-day low-residue diet and received two 250-mL enemas, one the night before TVS and the second 1-3 h before the examination. The presence of adhesions, number and size of rectosigmoid nodules, deepest layer of the rectum affected, percentage of the circumference of the bowel affected and distance from the most caudal part of the bowel nodule to the anal verge were determined. Patient tolerance to bowel preparation was assessed using a 5-point Likert scale, in which 1 represented 'very well tolerated' and 5 represented 'very poorly tolerated'. RESULTS The mean ± SD age of the 110 patients included in the study was 36.8 ± 5.07 years. As many as 55% of those identified during the first examination (TVS alone) as having adhesions were identified at the second examination (TVS with prior bowel preparation) as having rectosigmoid nodules, and 22 additional nodules were observed on TVS following bowel preparation. These newly detected rectosigmoid nodules, initially assessed mainly as adhesions, were smaller and more superficial compared with the nodules detected on TVS alone, or located in the anterior sigmoid wall. Patient tolerance overall to bowel preparation scored a mean of 1.81 on the 5-point Likert scale. CONCLUSIONS Bowel preparation is well tolerated by patients. When bowel preparation is performed before TVS, the detection of small and superficial nodules and those in the anterior sigmoid wall is improved, allowing more detailed description of these nodules in patients with suspected endometriosis. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- C Ros
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M Rius
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - M S Abrao
- Endometriosis Section, Gynecologic Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Department of Obstetrics and Gynaecology, São Paulo University, São Paulo, Brazil
- Gynecologic Division, BP - A Beneficencia Portuguesa de São Paulo, São Paulo, Brazil
| | - C deGuirior
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - M Á Martínez-Zamora
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M Gracia
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - F Carmona
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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12
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Infertility in women with bowel endometriosis: first-line assisted reproductive technology results in satisfactory cumulative live-birth rates. Fertil Steril 2020; 115:692-701. [PMID: 33276963 DOI: 10.1016/j.fertnstert.2020.09.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the assisted reproductive technology (ART) cumulative live-birth rate (LBR) in a cohort of bowel endometriosis patients with no prior history of surgery for endometriosis. DESIGN Prospective cohort study. SETTING University hospital. PATIENT(S) One hundred and one consecutive infertile bowel-endometriosis patients with no prior history of surgery for endometriosis in whom the diagnosis of endometriosis was based on published imaging criteria using transvaginal sonography and magnetic resonance imaging. INTERVENTION(S) First-line ART. MAIN OUTCOME MEASURE(S) Cumulative LBR, with statistical analysis via Kaplan Meier method with a "conservative" method, whereby it was assumed that no live births took place for patients who did not return. RESULT(S) Between January 2016 and December 2018, 101 bowel endometriosis patients underwent 176 ART cycles. The mean number of deep-infiltrating endometriosis lesions per patient was 3 ± 0.9, with a mean number of bowel lesions of 1.3 ± 0.6. Seventy-three percent of the patients had associated endometriomas, and 88.1% had associated adenomyosis. Overall, the cumulative LBR after four ART cycles was 64.4%, using the conservative Kaplan-Meier method. CONCLUSION(S) The ART cumulative LBR was very satisfactory (64.4%) in bowel endometriosis patients with no prior history of surgery for endometriosis. In light of these data, clinicians should carefully weigh the pros and cons before systematically referring infertile bowel endometriosis patients to fertility-preserving surgery because as first-line ART appears to offer satisfactory results.
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Capezzuoli T, Vannuccini S, Mautone D, Sorbi F, Chen H, Reis FM, Ceccaroni M, Petraglia F. Long-term hormonal treatment reduces repetitive surgery for endometriosis recurrence. Reprod Biomed Online 2020; 42:451-456. [PMID: 33277193 DOI: 10.1016/j.rbmo.2020.09.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/05/2020] [Accepted: 09/17/2020] [Indexed: 12/16/2022]
Abstract
RESEARCH QUESTION How effective is medical hormonal treatment in preventing endometriosis recurrence and in improving women's clinical symptoms and quality of life? DESIGN This observational cross-sectional study evaluated the effects of hormonal medical treatment (progestins, gonadotrophin-releasing hormone analogues or continuous oral contraceptives) on endometriosis recurrence, current clinical symptoms and quality of life in three groups of patients: Group A (n = 34), no hormonal treatment either before or after the first endometriosis surgery; Group B (n = 76), on hormonal treatment after the first endometriosis surgery; and Group C (n = 75), on hormonal treatment both before and after the first endometriosis surgery. RESULTS Group C patients were characterized by a lower rate of endometriosis reoperation (P = 0.011) and a lower rate of dysmenorrhoea (P = 0.006). Women who experienced repetitive endometriosis surgery showed worse physical (P = 0.004) and mental (P = 0.012) status than those who received a single surgery, independent of the treatment. CONCLUSION Hormonal treatments represent a valid cornerstone of endometriosis management and may be useful as an alternative to surgery, but also before surgery, to plan better, and after surgery in order to reduce the risk of recurrence. Medical counselling is very helpful in choosing the correct and individualized endometriosis treatment. In fact, the gold standard for modern endometriosis management is the individualized approach and surgery should be considered, depending on the clinical situation and a patient's symptoms.
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Affiliation(s)
- Tommaso Capezzuoli
- Department of Clinical Experimental and Biomedical Sciences, University of Florence Florence, Italy
| | - Silvia Vannuccini
- Obstetrics and Gynecology, Department of Maternity and Infancy, AOU Careggi Florence, Italy; Department of Molecular and Developmental Medicine, University of Siena Siena, Italy
| | - Daniele Mautone
- Gynecology and Obstetrics, Gynecologic Oncology, Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS Sacro Cuore Don Calabria Hospital, Negar di Valpolicella, Verona, Italy
| | - Flavia Sorbi
- Department of Clinical Experimental and Biomedical Sciences, University of Florence Florence, Italy
| | - Huixi Chen
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai, China
| | - Fernando M Reis
- Universidade Federal de Minas Gerais, Division of Human Reproduction, Belo Horizonte, Brazil
| | - Marcello Ceccaroni
- Gynecology and Obstetrics, Gynecologic Oncology, Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS Sacro Cuore Don Calabria Hospital, Negar di Valpolicella, Verona, Italy
| | - Felice Petraglia
- Department of Clinical Experimental and Biomedical Sciences, University of Florence Florence, Italy.
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Focal adenomyosis of the outer myometrium and deep infiltrating endometriosis severity. Fertil Steril 2020; 114:818-827. [PMID: 32741618 DOI: 10.1016/j.fertnstert.2020.05.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/28/2020] [Accepted: 05/02/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine whether the presence of focal adenomyosis of the outer myometrium (FAOM) at preoperative magnetic resonance imaging is associated with the severity of deep infiltrating endometriosis. DESIGN Observational cross-sectional study involving 255 symptomatic deep infiltrating endometriosis patients. Comparisons were performed according to the presence of FAOM. SETTING University hospital. PATIENT(S) Women with a preoperative magnetic resonance imaging and complete surgical exeresis of endometriotic lesions with histologically documented deep infiltrating endometriosis. INTERVENTION(S) Surgical management for deep infiltrating endometriosis. MAIN OUTCOME MEASURE(S) The presence of multiple deep infiltrating endometriosis lesions, the mean number and location of deep infiltrating endometriosis lesions, and the mean total revised American Society for Reproductive Medicine scores. RESULT(S) The prevalence of FAOM at preoperative magnetic resonance imaging in the 255 patients with deep infiltrating endometriosis was 56.5%. The mean number of deep infiltrating endometriosis lesions was significantly higher in the FAOM(+) group than in the FAOM(-) group: 3.5 ± 2.1 vs. 2.2 ± 1.5. The mean total revised American Society for Reproductive Medicine score was higher in case of FOAM coexisting with deep infiltrating endometriosis. After adjusting for confounding factors, the presence of FAOM was significantly associated with multiple deep lesions. CONCLUSION(S) FAOM was significantly associated with greater deep infiltrating endometriosis severity. This needs to be integrated into the management strategy. Furthermore, a pathogenic link between deep infiltrating endometriosis and FAOM cannot be excluded.
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Maignien C, Santulli P, Bourdon M, Korb D, Marcellin L, Lamau MC, Chapron C. Deep Infiltrating Endometriosis: a Previous History of Surgery for Endometriosis May Negatively Affect Assisted Reproductive Technology Outcomes. Reprod Sci 2020; 27:545-554. [DOI: 10.1007/s43032-019-00052-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 07/23/2019] [Indexed: 11/29/2022]
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Vannuccini S, Reis FM, Coutinho LM, Lazzeri L, Centini G, Petraglia F. Surgical treatment of endometriosis: prognostic factors for better quality of life. Gynecol Endocrinol 2019; 35:1010-1014. [PMID: 31155975 DOI: 10.1080/09513590.2019.1616688] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The present study investigated the effect of surgical treatment of endometriosis on physical and mental health. We undertook a prospective survey including 153 premenopausal women with histological diagnosis of endometriosis. The Short Form 12 (SF-12) questionnaire comprising physical and mental component scales was used. Two groups of patients were distinguished: Group A (n = 42) with SF-12 scores above the median in both physical and mental scales; Group B (n = 111) with SF-12 scores below the median in either physical or mental scale. Group A was diagnosed and operated for endometriosis for the first time at an older age (30 vs. 26 years), had undergone more frequently a single surgical intervention (64% vs. 46%), was less affected by symptom or lesion recurrence and had reported less intense current pain symptoms than Group B. Having the first endometriosis surgery at a later age was an independent predictor of better health status (adjusted odds ratio 1.146 per year, 95% confidence interval 1.058-1.242) after accounting for the potential confounding effects of reoperation, pelvic pain and time elapsed since the first surgery. In conclusion, patients with endometriosis who had a single surgery at an older age have good symptom control and better quality of life (QoL).
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Affiliation(s)
- Silvia Vannuccini
- Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Florence, Careggi University Hospital , Florence , Italy
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University Hospital of Siena , Siena , Italy
| | - Fernando M Reis
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Larissa M Coutinho
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
- Department of Maternal and Child Health, Universidade Federal de Juiz de Fora , Juiz de Fora , Brazil
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University Hospital of Siena , Siena , Italy
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University Hospital of Siena , Siena , Italy
| | - Felice Petraglia
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital , Florence , Italy
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Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol 2019; 15:666-682. [PMID: 31488888 DOI: 10.1038/s41574-019-0245-z] [Citation(s) in RCA: 426] [Impact Index Per Article: 85.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2019] [Indexed: 02/08/2023]
Abstract
Endometriosis is a chronic inflammatory disease defined as the presence of endometrial tissue outside the uterus, which causes pelvic pain and infertility. This disease should be viewed as a public health problem with a major effect on the quality of life of women as well as being a substantial economic burden. In light of the considerable progress with diagnostic imaging (for example, transvaginal ultrasound and MRI), exploratory laparoscopy should no longer be used to diagnose endometriotic lesions. Instead, diagnosis of endometriosis should be based on a structured process involving the combination of patient interviews, clinical examination and imaging. Notably, a diagnosis of endometriosis often leads to immediate surgery. Therefore, rethinking the diagnosis and management of endometriosis is warranted. Instead of assessing endometriosis on the day of the diagnosis, gynaecologists should consider the patient's 'endometriosis life'. Medical treatment is the first-line therapeutic option for patients with pelvic pain and no desire for immediate pregnancy. In women with infertility, careful consideration should be made regarding whether to provide assisted reproductive technologies prior to performing endometriosis surgery. Modern endometriosis management should be individualized with a patient-centred, multi-modal and interdisciplinary integrated approach.
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Affiliation(s)
- Charles Chapron
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France.
- Department 'Development, Reproduction and Cancer', Institut Cochin, INSERM U1016, Université Paris Descartes, Paris, France.
| | - Louis Marcellin
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Department 'Development, Reproduction and Cancer', Institut Cochin, INSERM U1016, Université Paris Descartes, Paris, France
| | - Bruno Borghese
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Department 'Development, Reproduction and Cancer', Institut Cochin, INSERM U1016, Université Paris Descartes, Paris, France
| | - Pietro Santulli
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Department 'Development, Reproduction and Cancer', Institut Cochin, INSERM U1016, Université Paris Descartes, Paris, France
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Marcellin L, Leconte M, Gaujoux S, Santulli P, Borghese B, Chapron C, Dousset B. Associated ileocaecal location is a marker for greater severity of low rectal endometriosis. BJOG 2019; 126:1600-1608. [DOI: 10.1111/1471-0528.15901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2019] [Indexed: 12/23/2022]
Affiliation(s)
- L Marcellin
- Département de Gynécologie Obsétrique II et Médecine de la Reproduction (Professeur Chapron) Assistance Publique‐Hôpitaux de Paris (AP‐HP) Centre Hospitalier Universitaire (CHU) Cochin Hôpital Universitaire Paris Centre (HUPC) Paris France
- Université Paris Descartes Sorbonne Paris Cité Paris France
| | - M Leconte
- Université Paris Descartes Sorbonne Paris Cité Paris France
- Service de Chirurgie Digestive Hépato‐biliaire et Endocrinienne Assistance, Publique‐Hôpitaux de Paris (AP‐HP) Centre Hospitalier Universitaire (CHU) Cochin Hôpital Universitaire, Paris Centre (HUPC) Paris France
| | - S Gaujoux
- Université Paris Descartes Sorbonne Paris Cité Paris France
- Service de Chirurgie Digestive Hépato‐biliaire et Endocrinienne Assistance, Publique‐Hôpitaux de Paris (AP‐HP) Centre Hospitalier Universitaire (CHU) Cochin Hôpital Universitaire, Paris Centre (HUPC) Paris France
| | - P Santulli
- Département de Gynécologie Obsétrique II et Médecine de la Reproduction (Professeur Chapron) Assistance Publique‐Hôpitaux de Paris (AP‐HP) Centre Hospitalier Universitaire (CHU) Cochin Hôpital Universitaire Paris Centre (HUPC) Paris France
- Université Paris Descartes Sorbonne Paris Cité Paris France
| | - B Borghese
- Département de Gynécologie Obsétrique II et Médecine de la Reproduction (Professeur Chapron) Assistance Publique‐Hôpitaux de Paris (AP‐HP) Centre Hospitalier Universitaire (CHU) Cochin Hôpital Universitaire Paris Centre (HUPC) Paris France
- Université Paris Descartes Sorbonne Paris Cité Paris France
| | - C Chapron
- Département de Gynécologie Obsétrique II et Médecine de la Reproduction (Professeur Chapron) Assistance Publique‐Hôpitaux de Paris (AP‐HP) Centre Hospitalier Universitaire (CHU) Cochin Hôpital Universitaire Paris Centre (HUPC) Paris France
- Université Paris Descartes Sorbonne Paris Cité Paris France
| | - B Dousset
- Université Paris Descartes Sorbonne Paris Cité Paris France
- Service de Chirurgie Digestive Hépato‐biliaire et Endocrinienne Assistance, Publique‐Hôpitaux de Paris (AP‐HP) Centre Hospitalier Universitaire (CHU) Cochin Hôpital Universitaire, Paris Centre (HUPC) Paris France
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Santulli P, Tran C, Gayet V, Bourdon M, Maignien C, Marcellin L, Pocate-Cheriet K, Chapron C, de Ziegler D. Oligo-anovulation is not a rarer feature in women with documented endometriosis. Fertil Steril 2019; 110:941-948. [PMID: 30316441 DOI: 10.1016/j.fertnstert.2018.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the prevalence of oligo-anovulation in women suffering from endometriosis compared to that of women without endometriosis. DESIGN A single-center, cross-sectional study. SETTING University hospital-based research center. PATIENT (S) We included 354 women with histologically proven endometriosis and 474 women in whom endometriosis was surgically ruled out between 2004 and 2016. INTERVENTION None. MAIN OUTCOME MEASURE(S) Frequency of oligo-anovulation in women with endometriosis as compared to that prevailing in the disease-free reference group. RESULTS There was no difference in the rate of oligo-anovulation between women with endometriosis (15.0%) and the reference group (11.2%). Regarding the endometriosis phenotype, oligo-anovulation was reported in 12 (18.2%) superficial peritoneal endometriosis, 12 (10.6%) ovarian endometrioma, and 29 (16.6%) deep infiltrating endometriosis. CONCLUSION(S) Endometriosis should not be discounted in women presenting with oligo-anovulation.
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Affiliation(s)
- Pietro Santulli
- Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Department of Development, Reproduction and Cancer, Institut Cochin, INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Chloe Tran
- Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Vanessa Gayet
- Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Mathilde Bourdon
- Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Department of Development, Reproduction and Cancer, Institut Cochin, INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Chloe Maignien
- Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Louis Marcellin
- Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Department of Development, Reproduction and Cancer, Institut Cochin, INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Khaled Pocate-Cheriet
- Department of Development, Reproduction and Cancer, Institut Cochin, INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Charles Chapron
- Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Department of Development, Reproduction and Cancer, Institut Cochin, INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Dominique de Ziegler
- Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
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Bolze PA, Descargues P, Poilblanc M, Cotte E, Sesques A, Paparel P, Charlot M, Hajri T, Rousset P, Golfier F. [Contribution of meb to endometriosis patients' diagnosis and treatment]. ACTA ACUST UNITED AC 2018; 47:3-10. [PMID: 30563784 DOI: 10.1016/j.gofs.2018.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Diagnosis and treatment of endometriosis may be complex and therefore justify the discussion of therapeutic decisions in a multidisciplinary endometriosis board (MEB). The development of endometriosis regional expert centers requires an assessment of the quality and relevance of MEB. METHODS Qualitiative retrospective study on patients whose management was discussed in Centre Hospitalier Lyon-Sud between June 2013 and December 2017. RESULTS Among 376 patients presented in MEB, 309 (80.2%) were painful and 184 (59.5%) had complex endometriosis. A complete clinical evaluation was performed in 120 (38.8%) patients. MRI was performed for 370 (98.4%) patients including 303 (81.9%) with a second reading by an expert radiologist. These second readings allowed a diagnosis correction in 88 (60.7 %) patients with complex endometriosis. MR enterography (27.8 %) and rectal endoscopic sonography (14.4%) were the most frequently used third-line exams to complete the initial imaging of digestive lesion in patients with rectal endometriosis. Surgery was proposed for 199 (52,9%) patients including 108 (58,7%) with complex endometriosis. CONCLUSION One of the major interests of MEB in endometriosis is the second reading of MRI, which, by identifying complex endometriosis initially undiagnosed or underestimated, enabled to better discuss the benefits/risks of therapeutic choices, and to organize complex surgeries when those were retained. The development of MEB in regional expert centers will contribute to optimizing the relevance of care for patients with endometriosis.
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Affiliation(s)
- P A Bolze
- Service de chirurgie gynécologique et oncologique - obstétrique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - P Descargues
- Service de chirurgie gynécologique et oncologique - obstétrique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
| | - M Poilblanc
- Service de chirurgie gynécologique et oncologique - obstétrique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - E Cotte
- Service de chirurgie digestive, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - A Sesques
- Service de chirurgie gynécologique et oncologique - obstétrique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Service de médecine de la reproduction, hospices civils de Lyon, université Claude-Bernard Lyon 1, hôpital Femme-Mère-Enfant, 56, boulevard Pinel, 69500 Bron, France
| | - P Paparel
- Service de chirurgie urologique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - M Charlot
- Service d'imagerie médicale, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - T Hajri
- Service de chirurgie gynécologique et oncologique - obstétrique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - P Rousset
- Service d'imagerie médicale, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - F Golfier
- Service de chirurgie gynécologique et oncologique - obstétrique, hospices civils de Lyon, université Claude-Bernard Lyon 1, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
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Ovarian endometriosis and infertility: in vitro fertilization (IVF) or surgery as the first approach? Fertil Steril 2018; 110:1218-1226. [DOI: 10.1016/j.fertnstert.2018.10.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 10/02/2018] [Indexed: 01/01/2023]
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Al-Taher M, Hsien S, Schols RM, Hanegem NV, Bouvy ND, Dunselman GAJ, Stassen LPS. Intraoperative enhanced imaging for detection of endometriosis: A systematic review of the literature. Eur J Obstet Gynecol Reprod Biol 2018; 224:108-116. [PMID: 29573627 DOI: 10.1016/j.ejogrb.2018.03.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 03/08/2018] [Accepted: 03/12/2018] [Indexed: 01/09/2023]
Abstract
The diagnosis of peritoneal endometriosis during laparoscopy may be difficult due to the polymorphic aspects of the lesions. Enhanced imaging using contrast agents has potential to provide a better identification of peritoneal endometriosis. The aim of this systematic review is to provide an overview of the literature on what is known about the intraoperative laparoscopic visual enhancement of peritoneal endometriosis using contrast agents. A systematic review was done of studies about enhanced imaging during laparoscopy for endometriosis using contrast agents. Clinical studies which contained a description of imaging with a contrast agent and also reported visual findings of endometriosis during laparoscopy, were included. Nine suitable studies were identified. Intraoperative visualization of endometriosis was analyzed with or without histologic confirmation. Four studies evaluated 5-aminolevulinic acid-induced fluorescence (5-ALA), 1 study evaluated indigo carmine, 2 studies evaluated methylene blue (MB), 1 study evaluated indocyanine green (ICG) and 1 study evaluated so-called bloody peritoneal fluid painting. All studies, with a combined total of 171 included patients, showed potential of enhanced visibility of endometriosis using contrast agents. A combined total of 7 complications, all related to the use of 5-ALA, were reported. We conclude that the use of contrast-based enhanced imaging during laparoscopy is promising and that it can provide a better visualization of peritoneal endometriosis. However, based on the limited data no technique of preference can yet be identified.
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Affiliation(s)
- Mahdi Al-Taher
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Shugi Hsien
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rutger M Schols
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nehalennia Van Hanegem
- Maastricht University Medical Center, Department of Obstetrics & Gynaecology, Research Institute GROW, Maastricht, The Netherlands
| | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Gerard A J Dunselman
- Maastricht University Medical Center, Department of Obstetrics & Gynaecology, Research Institute GROW, Maastricht, The Netherlands
| | - Laurents P S Stassen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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Borghese B, Santulli P, Marcellin L, Chapron C. [Definition, description, clinicopathological features, pathogenesis and natural history of endometriosis: CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018. [PMID: 29540335 DOI: 10.1016/j.gofs.2018.02.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Endometriosis and adenomyosis are histologically defined. The frequency of endometriosis cannot be precisely estimated in the general population. Endometriosis is considered a disease when it causes pain and/or infertility. Endometriosis is a heterogeneous disease with three well-recognized subtypes that are often associated with each other: superficial endometriosis (SUP), ovarian endometrioma (OMA), and deep infiltrating endometriosis (DIE). DIE is frequently multifocal and mainly affects the following structures: the uterosacral ligaments, the posterior vaginal cul-de-sac, the bladder, the ureters, and the digestive tract (rectum, recto-sigmoid junction, appendix). The role of menstrual reflux in the pathophysiology of endometriosis is major and explains the asymmetric distribution of lesions, which predominate in the posterior compartment of the pelvis and on the left (NP3). All factors favoring menstrual reflux increase the risk of endometriosis (early menarche, short cycles, AUB, etc.). Inflammation and biosteroid hormones synthesis are the main mechanisms favoring the implantation and the growth of the lesions. Pain associated with endometriosis can be explained by nociception, hyperalgia, and central sensitization, associated to varying degrees in a single patient. Typology of pain (dysmenorrhea, deep dyspareunia, digestive or urinary symptoms) is correlated with the location of the lesions. Infertility associated with endometriosis can be explained by several non-exclusive mechanisms: a pelvic factor (inflammation), disrupting natural fertilization; an ovarian factor, related to oocyte quality and/or quantity; a uterine factor disrupting implantation. The pelvic factor can be fixed by surgical excision of the lesions that improves the chance of natural conception (NP2). The uterine factor can be corrected by an ovulation-blocking treatment that improves the chances of getting pregnant by in vitro fertilization (NP2). The impact of endometrioma exeresis on the ovarian reserve (NP2) should be considered when a surgery is scheduled. Endometriosis is a multifactorial disease, resulting from combined action of genetic and environmental factors. The risk of developing endometriosis for a first-degree relative is five times higher than in the general population (NP2). Identification of genetic variants involved in the disease has no implication for clinical practice for the moment. The role of environmental factors, particularly endocrine disrupters, is plausible but not demonstrated. Literature review does not support the progression of endometriosis over time, either in terms of the volume or the number of the lesions (NP3). The risk of acute digestive occlusion or functional loss of a kidney in patients followed for endometriosis seems exceptional. These complications were revealing the disease in the majority of cases. IVF does not increase the intensity of pain associated with endometriosis (NP2). There is few data on the influence of pregnancy on the lesions, except the possibility of a decidualization of the lesions that may give them a suspicious aspect on imaging. The impact of endometriosis on pregnancy is debated. There is an epidemiological association between endometriosis and rare subtypes of ovarian cancer (endometrioid and clear cell carcinomas) (NP2). However, the relative risk is moderate (around 1.3) (NP2) and the causal relationship between endometriosis and ovarian cancer is not demonstrated so far. Considering the low incidence of endometriosis-associated ovarian cancer, there is no argument to propose a screening or a risk reducing strategy for the patients.
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Affiliation(s)
- B Borghese
- Service de chirurgie gynécologie obstétrique 2 et médecine de la reproduction, CHU Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Équipe génomique, épigénétique et physiopathologie de la reproduction, Inserm U1016, département développement, reproduction, cancer, université Paris Descartes, Sorbonne Paris cité, 12, rue de l'École-de-médecine, 75270 Paris cedex 06, France.
| | - P Santulli
- Service de chirurgie gynécologie obstétrique 2 et médecine de la reproduction, CHU Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Équipe génomique, épigénétique et physiopathologie de la reproduction, Inserm U1016, département développement, reproduction, cancer, université Paris Descartes, Sorbonne Paris cité, 12, rue de l'École-de-médecine, 75270 Paris cedex 06, France
| | - L Marcellin
- Service de chirurgie gynécologie obstétrique 2 et médecine de la reproduction, CHU Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Équipe stress oxydant, prolifération cellulaire et inflammation, Inserm U1016, département développement, reproduction, cancer, université Paris Descartes, Sorbonne Paris cité, 12, rue de l'École-de-médecine, 75270 Paris cedex 06, France
| | - C Chapron
- Service de chirurgie gynécologie obstétrique 2 et médecine de la reproduction, CHU Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Équipe génomique, épigénétique et physiopathologie de la reproduction, Inserm U1016, département développement, reproduction, cancer, université Paris Descartes, Sorbonne Paris cité, 12, rue de l'École-de-médecine, 75270 Paris cedex 06, France
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Grundström H, Alehagen S, Berterö C, Kjølhede P. Impact of Pelvic Pain and Endometriosis on Patient-Reported Outcomes and Experiences of Benign Hysterectomy: A Study from the Swedish National Register for Gynecological Surgery. J Womens Health (Larchmt) 2017; 27:691-698. [PMID: 29148910 DOI: 10.1089/jwh.2017.6546] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The study objective was to analyze and compare patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs) after hysterectomy in women with and without a preoperative complaint of pelvic pain associated with and without a confirmed diagnosis of endometriosis. METHODS Retrospective nationwide register study. Data on 28,776 hysterectomies performed on benign indication between 2004 and 2016 were retrieved from the Swedish National Register for Gynecological Surgery. Multivariable logistic regression models were used to compare the PREMs and PROMs items. The results are presented as adjusted odds ratios (aORs) and 95% confidence intervals (CI). RESULTS Regardless of the occurrence of pelvic pain preoperatively and a diagnosis of endometriosis, 1 year after surgery, the women were satisfied or very satisfied (>90%) with the hysterectomy, and their medical condition was improved or much improved (>95%). The women with a preoperative complaint of pelvic pain and endometriosis more often reported excessively short hospital stays (aOR 1.45, 95% CI 1.17-1.79), more severe complications after discharge (aOR 2.02, 95% CI 1.59-2.66) at the 8-week follow-up and at the 1-year follow-up (aOR 2.31, 95% CI 1.57-3.39), and more dissatisfaction with the operation (aOR 1.83, 95% CI 1.35-2.48) than preoperative pelvic pain-free women without endometriosis at the 1-year follow-up. CONCLUSIONS The majority of the women were satisfied after their hysterectomy. The women with pelvic pain and endometriosis were at a higher risk of being dissatisfied. Pelvic pain per se seemed to be the main factor affecting the rating in the PREMs and PROMs, and the endometriosis was a significant contributing factor.
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Affiliation(s)
- Hanna Grundström
- 1 Department of Obstetrics and Gynecology, Vrinnevi Hospital , Norrköping, Sweden .,2 Department of Medical and Health Sciences, Faculty of Medicine and Health Science, Linköping University , Linköping, Sweden
| | - Siw Alehagen
- 2 Department of Medical and Health Sciences, Faculty of Medicine and Health Science, Linköping University , Linköping, Sweden
| | - Carina Berterö
- 2 Department of Medical and Health Sciences, Faculty of Medicine and Health Science, Linköping University , Linköping, Sweden
| | - Preben Kjølhede
- 3 Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Linköping University , Linköping, Sweden .,4 Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Science, Linköping University , Linköping, Sweden
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Endometriosis, especially mild disease: a risk factor for miscarriages. Fertil Steril 2017; 108:806-814.e2. [PMID: 29079275 DOI: 10.1016/j.fertnstert.2017.08.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/07/2017] [Accepted: 08/14/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate the prevalence of miscarriage in women with endometriosis (WwE) compared with disease-free control women (CW). DESIGN Cross-sectional analysis nested in a retrospective observational study (n = 940). SETTING Hospitals and associated private practices. PATIENT(S) Previously pregnant women (n = 268) within reproductive age in matched pairs. INTERVENTION(S) Retrospective analysis of surgical reports and self-administered questionnaires. MAIN OUTCOME MEASURE(S) Rate of miscarriage, subanalysis for fertility status (≤12 vs. >12 months' time to conception), endometriosis stages (revised American Society of Reproductive Medicine classification [rASRM] I/II vs. III/IV) and phenotypic localizations (superficial peritoneal, ovarian, and deep infiltrating endometriosis). RESULT(S) The miscarriage rate was higher in WwE (35.8% [95% confidence interval 29.6%-42.0%]) compared with CW (22.0% [16.7%-27.0%]); adjusted incidence risk ratio of 1.97 (95% CI 1.41-2.75). This remained significant in subfertile WwE (50.0% [40.7%-59.4%]) vs. CW (25.8% [8.5%-41.2%]) but not in fertile WwE (24.5% [16.3%-31.6%]) vs. CW (21.5% [15.9%-26.8%]). The miscarriage rate was higher in women with milder forms (rASRM I/II 42.1% [32.6%-51.4%] vs. rASRM III/IV 30.8% [22.6%-38.7%], compared with 22.0% [16.7%-27.0%] in CW), and in women with superficial peritoneal endometriosis (42.0% [32.0%-53.9%]) compared with ovarian endometriosis (28.6% [17.7%-38.7%]) and deep infiltrating endometriosis (33.9% [21.2%-46.0%]) compared with CW (22.0% [16.7%-27.0%]). CONCLUSION(S) Mild endometriosis, as in superficial lesions, is related to a great extent of inflammatory disorder, possibly leading to defective folliculogenesis, fertilization, and/or implantation, presenting as increased risk of miscarriage. CLINICAL TRIAL REGISTRATION NUMBER NCT02511626.
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Progress in the diagnosis and management of adolescent endometriosis: an opinion. Reprod Biomed Online 2017; 36:102-114. [PMID: 29174167 DOI: 10.1016/j.rbmo.2017.09.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 09/27/2017] [Accepted: 09/28/2017] [Indexed: 11/24/2022]
Abstract
Increasing evidence indicates that early onset endometriosis (EOE), starting around menarche or early adolescence, may have an origin different from the adult variant, originating from neonatal uterine bleeding (NUB). This implies seeding of naïve endometrial progenitor cells into the pelvic cavity with NUB; these can then activate around thelarche. It has its own pathophysiology, symptomatology and risk factors, warranting critical management re-evaluation. It can also be progressive, endangering future reproductive capacity. This variant seems to be characterized by the presence of ovarian endometrioma. Today, the diagnosis of endometriosis in young patients is often delayed for years; if rapidly progressive, it can severely affect pelvic organs, even in the absence of serious symptoms. Given the predicament, great attention must be paid to symptomatology that is often non-specific, justifying a search for new, simple, non-invasive markers of increased risk. Better use of modern imaging techniques will aid considerably in screening for the presence of EOE. Traditional laparoscopy should be limited to cases in which imaging gives rise to suspicion of severity and a stepwise, minimally invasive approach should be used, followed by medical treatment to prevent recurrence. In conclusion, EOE represents a condition necessitating early diagnosis and stepwise management, including medical treatment.
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Chapron C, Tosti C, Marcellin L, Bourdon M, Lafay-Pillet MC, Millischer AE, Streuli I, Borghese B, Petraglia F, Santulli P. Relationship between the magnetic resonance imaging appearance of adenomyosis and endometriosis phenotypes. Hum Reprod 2017; 32:1393-1401. [DOI: 10.1093/humrep/dex088] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 04/23/2017] [Indexed: 01/03/2023] Open
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Maignien C, Santulli P, Gayet V, Lafay-Pillet MC, Korb D, Bourdon M, Marcellin L, de Ziegler D, Chapron C. Prognostic factors for assisted reproductive technology in women with endometriosis-related infertility. Am J Obstet Gynecol 2017; 216:280.e1-280.e9. [PMID: 27899313 DOI: 10.1016/j.ajog.2016.11.1042] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/21/2016] [Accepted: 11/21/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Assisted reproductive technology is one of the therapeutic options offered for managing endometriosis-associated infertility. Yet, published data on assisted reproductive technology outcome in women affected by endometriosis are conflicting and the determinant factors for pregnancy chances unclear. OBJECTIVE We sought to evaluate assisted reproductive technology outcomes in a series of 359 endometriosis patients, to identify prognostic factors and determine if there is an impact of the endometriosis phenotype. STUDY DESIGN This was a retrospective observational cohort study, including 359 consecutive endometriosis patients undergoing in vitro fertilization or intracytoplasmic sperm injection, from June 2005 through February 2013 at a university hospital. Endometriotic lesions were classified into 3 phenotypes-superficial peritoneal endometriosis, endometrioma, or deep infiltrating endometriosis-based on imaging criteria (transvaginal ultrasound, magnetic resonance imaging); histological proof confirmed the diagnosis in women with a history of surgery for endometriosis. Main outcome measures were clinical pregnancy rates and live birth rates per cycle and per embryo transfer. Prognostic factors of assisted reproductive technology outcome were identified by comparing women who became pregnant and those who did not, using univariate and adjusted multiple logistic regression models. RESULTS In all, 359 endometriosis patients underwent 720 assisted reproductive technology cycles. In all, 158 (44%) patients became pregnant, and 114 (31.8%) had a live birth. The clinical pregnancy rate and the live birth rate per embryo transfer were 36.4% and 22.8%, respectively. The endometriosis phenotype (superficial endometriosis, endometrioma, or deep infiltrating endometriosis) had no impact on assisted reproductive technology outcomes. After multivariate analysis, history of surgery for endometriosis (odds ratio, 0.14; 95% confidence ratio, 0.06-0.38) or past surgery for endometrioma (odds ratio, 0.39; 95% confidence ratio, 0.18-0.84) were independent factors associated with lower pregnancy rates. Anti-müllerian hormone levels <2 ng/mL (odds ratio, 0.51; 95% confidence ratio, 0.28-0.91) and antral follicle count <10 (odds ratio, 0.27; 95% confidence ratio, 0.14-0.53) were also associated with negative assisted reproductive technology outcomes. CONCLUSION The endometriosis phenotype seems to have no impact on assisted reproductive technology results. An altered ovarian reserve and a previous surgery for endometriosis and/or endometrioma are associated with decreased pregnancy rates.
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Estrogen-progestins and progestins for the management of endometriosis. Fertil Steril 2016; 106:1552-1571.e2. [DOI: 10.1016/j.fertnstert.2016.10.022] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/10/2016] [Accepted: 10/12/2016] [Indexed: 02/08/2023]
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Full-Thickness Excision versus Shaving by Laparoscopy for Intestinal Deep Infiltrating Endometriosis: Rationale and Potential Treatment Options. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3617179. [PMID: 27579309 PMCID: PMC4989089 DOI: 10.1155/2016/3617179] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 04/08/2016] [Accepted: 07/18/2016] [Indexed: 01/16/2023]
Abstract
Endometriosis is defined as the presence of endometrial mucosa (glands and stroma) abnormally implanted in locations other than the uterine cavity. Deep infiltrating endometriosis (DIE) is considered the most aggressive presentation of the disease, penetrating more than 5 mm in affected tissues, and it is reported in approximately 20% of all women with endometriosis. DIE can cause a complete distortion of the pelvic anatomy and it mainly involves uterosacral ligaments, bladder, rectovaginal septum, rectum, and rectosigmoid colon. This review describes the state of the art in laparoscopic approach for DIE with a special interest in intestinal involvement, according to recent literature findings. Our attention has been focused particularly on full-thickness excision versus shaving technique in deep endometriosis intestinal involvement. Particularly, the aim of this paper is clarifying from the clinical and methodological points of view the best surgical treatment of deep intestinal endometriosis, since there is no standard of care in the literature and in different surgical settings. Indeed, this review tries to suggest when it is advisable to manage the full-thickness excision or the shaving technique, also analyzing perioperative management, main complications, and surgical outcomes.
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Santulli P, Lamau M, Marcellin L, Gayet V, Marzouk P, Borghese B, Lafay Pillet MC, Chapron C. Endometriosis-related infertility: ovarian endometriomaper seis not associated with presentation for infertility. Hum Reprod 2016; 31:1765-75. [DOI: 10.1093/humrep/dew093] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 03/23/2016] [Indexed: 11/14/2022] Open
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Vanhie A, Meuleman C, Tomassetti C, Timmerman D, D'Hoore A, Wolthuis A, Van Cleynenbreugel B, Dancet E, Van den Broeck U, Tsaltas J, Renner SP, Ebert AD, Carmona F, Abbott J, Stepniewska A, Taylor H, Saridogan E, Mueller M, Keckstein J, Pluchino N, Janik G, Zupi E, Minelli L, Cooper M, Dunselman G, Koh C, Abrao MS, Chapron C, D'Hooghe T. Consensus on Recording Deep Endometriosis Surgery: the CORDES statement. Hum Reprod 2016; 31:1219-23. [PMID: 27094477 DOI: 10.1093/humrep/dew067] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/05/2016] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Which essential items should be recorded before, during and after endometriosis surgery and in clinical outcome based surgical trials in patients with deep endometriosis (DE)? SUMMARY ANSWER A DE surgical sheet (DESS) was developed for standardized reporting of the surgical treatment of DE and an international expert consensus proposal on relevant items that should be recorded in surgical outcome trials in women with DE. WHAT IS KNOWN ALREADY Surgery is an important treatment for symptomatic DE. So far, data have been reported in such a way that comparison of different surgical techniques is impossible. Therefore, we present an international expert proposal for standardized reporting of surgical treatment and surgical outcome trials in women with DE. STUDY DESIGN, SIZE, DURATION International expert consensus based on a systematic review of literature. PARTICIPANTS/MATERIALS, SETTING, METHODS Taking into account recommendations from Consolidated Standards of Reporting Trials (CONSORT), the Innovation Development Exploration Assessment and Long-term Study (IDEAL), the Initiative on Methods, Measurement and Pain Assessment in Clinical trials (IMMPACT) and the World Endometriosis Research Foundation Phenome and Biobanking Harmonisation Project (WERF EPHect), a systematic literature review on surgical treatment of DE was performed and resulted in a proposal for standardized reporting, adapted by contributions from eight members of the multidisciplinary Leuven University Hospitals Endometriosis Care Program, from 18 international experts and from audience feedback during three international meetings. MAIN RESULTS AND THE ROLE OF CHANCE We have developed the DESS to record in detail the surgical procedures for DE, and an international consensus on pre-, intra- and post-operative data that should be recorded in surgical outcome trials on DE. LIMITATIONS, REASONS FOR CAUTION The recommendations in this paper represent a consensus among international experts based on a systematic review of the literature. For several items and recommendations, high-quality RCTs were not available. Further research is needed to validate and evaluate the recommendations presented here. WIDER IMPLICATIONS OF THE FINDINGS This international expert consensus for standardized reporting of surgical treatment in women with DE, based on a systematic literature review and international consensus, can be used as a guideline to record and report surgical management of patients with DE and as a guideline to design, execute, interpret and compare clinical trials in this patient population. STUDY FUNDING/COMPETING INTERESTS None of the authors received funding for the development of this paper. M.A. reports personal fees and non-financial support from Bayer Pharma outside the submitted work; H.T. reports a grant from Pfizer and personal fees for being on the advisory board of Perrigo, Abbvie, Allergan and SPD. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- A Vanhie
- Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium
| | - C Meuleman
- Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium
| | - C Tomassetti
- Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium
| | - D Timmerman
- Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium
| | - A D'Hoore
- Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - A Wolthuis
- Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | | | - E Dancet
- Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium
| | - U Van den Broeck
- Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium
| | - J Tsaltas
- Monash Health and Monash University, Melbourne, VIC, Australia
| | - S P Renner
- Frauenklinik, Universitaetsklinikum Erlangen, Erlangen, Germany
| | - A D Ebert
- Praxis für Frauengesundheit, Gynäkologie und Geburtshilfe, Berlin, Germany
| | - F Carmona
- Service of Gynecology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - J Abbott
- Royal Hospital for Women and University of New South Wales, Sydney, Australia
| | - A Stepniewska
- Department of Obstetrics and Gynecology, Ospedale Sacro Cuore, Verona, Italy
| | - H Taylor
- Yale School of Medicine, New Haven, CT, USA
| | - E Saridogan
- University College London Hospitals, London, UK
| | - M Mueller
- Universitätsklinik für Frauenheilkunde, Universitätsspital Bern, Bern, Switzerland
| | - J Keckstein
- Landeskrankenanstalten-Betriebsgesellschaft (KABEG) and Landeskrankenhaus Villach, Abteilung für Gynäkologie und Geburtshilfe, Villach, Austria
| | - N Pluchino
- Department of Obstetrics and Gynecology, University Hospital of Geneva, Geneva, Switzerland
| | - G Janik
- Reproductive Specialty Center, Columbia St. Mary's Hospital, Milwaukee, WI, USA Medical College of Wisconsin, Milwaukee, WI, USA
| | - E Zupi
- University of Siena, Siena, Italy
| | - L Minelli
- Department of Obstetrics and Gynecology, Ospedale Sacro Cuore, Verona, Italy
| | - M Cooper
- Department of Obstetrics and Gynaecology, Sydney University, Sydney, Australia
| | - G Dunselman
- Department of Obstetrics & Gynaecology, Research Institute GROW, Maastricht, The Netherlands University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - C Koh
- Milwaukee Institute of Minimally Invasive Surgery, Milwaukee, WI, USA
| | - M S Abrao
- Division of Reproductive Medicine, Sirio Libanes Hospital, Sao Paulo, Brazil Division of Endometriosis, Department of Obstetrics and Gynaecology, São Paulo University, São Paulo, Brazil
| | - C Chapron
- Faculty of Medicine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France Department of Gynecology, Obstetrics, and Reproductive Medicine, Centre Hospitalier Universitaire Cochin of the Groupe Hospitalier Universitaire Ouest, Paris, France
| | - T D'Hooghe
- Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium Faculty of Medicine, Leuven University, Leuven, Belgium Faculty of Medicine, Yale University, New Haven, CT, USA
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Health Economic Burden of Deep Infiltrating Endometriosis Surgically Treated in a Referral Center. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2016. [DOI: 10.5301/je.5000238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose This retrospective study aimed to describe patient characteristics of women with deep infiltrating endometriosis [DIE] affecting the bowel and bladder treated in a referral center in Germany, and to calculate direct costs during inpatient stay for surgery. Methods Patient characteristics and cost-relevant factors of women with DIE of the bladder or bowel surgically treated during 2008-2012 in a referral center were gathered from medical records. Patient economic data were retrieved from the hospital's finance and accounts department. Results One hundred and forty-eight cases with clinical information and cost data were analyzed retrospectively. Most cases had bowel endometriosis (91%) and were classified as severe (66%). The women analyzed were in their reproductive peak years (34 years; SD 6.3 years), of normal weight (body mass index [BMI] 23; SD 4.0) and most of them were employed (80%). Nearly all women (95%) were affected by multiple symptoms at hospital admission and the majority had a prior diagnosis of endometriosis (76%). Mean total costs per case were €11,458 (95% CI: €10,589-€12,326). Forty-four percent of the total costs were mean staff costs (€5,039), 30% were mean infrastructure costs (€3,425) and 26% mean material costs (€2,993). Conclusions This study is the first to estimate the surgery-related direct costs of DIE in Germany from a hospital's perspective based on data from a specialized center. Resource utilization and total costs of DIE are substantial.
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Santulli P, Marcellin L, Menard S, Thubert T, Khoshnood B, Gayet V, Goffinet F, Ancel PY, Chapron C. Increased rate of spontaneous miscarriages in endometriosis-affected women. Hum Reprod 2016; 31:1014-23. [DOI: 10.1093/humrep/dew035] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 02/09/2016] [Indexed: 01/09/2023] Open
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Rousset P, Gregory J, Rousset-Jablonski C, Hugon-Rodin J, Regnard JF, Chapron C, Coste J, Golfier F, Revel MP. MR diagnosis of diaphragmatic endometriosis. Eur Radiol 2016; 26:3968-3977. [PMID: 26868500 DOI: 10.1007/s00330-016-4226-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 01/05/2016] [Accepted: 01/15/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate magnetic resonance imaging (MRI) for diaphragmatic endometriosis diagnosis. MATERIALS AND METHODS Over a 2-year period, all diaphragmatic MRI performed in the context of diaphragmatic endometriosis were reviewed. Axial and coronal fat-suppressed T1- and T2-weighted sequences were analyzed by two independent readers for the presence of nodules, plaque lesions, micronodule clustering, or focal liver herniation. MR abnormalities were correlated to surgical findings in women surgically treated. Interobserver agreement was assessed by κ statistics. RESULTS Twenty-three women with diaphragmatic endometriosis criteria comprised the population; 14 had surgical confirmation and nine had symptoms relief with hormonal treatment. MRI sensitivity was 83 % (19/23; 95 % confidence interval [CI]: 68, 98) for reader 1 and 78 % (18/23; 95 % CI: 61, 95) for reader 2. Kappa value was 0.86 (95 % CI: 0.47, 1.00). Readers 1 and 2 detected 35 and 36 lesions, respectively, all right-sided and agreed for 32 lesions on the type, location, and signal. Lesions were mostly nodules (23/32, 72 %), predominantly posterior (28/32, 87.5 %) and hyperintense on T1 (20/32, 63 %). MRI was negative for both readers in 2 surgically treated patients with small nodules or isolated diaphragmatic holes. CONCLUSION MRI allows diaphragmatic endometriosis diagnosis with 78 to 83 % sensitivity and excellent interobserver agreement. KEY POINTS • MRI allows the diagnosis of diaphragmatic endometriosis with up to 83 % sensitivity. • Diaphragmatic endometriosis lesions are better depicted on fat-suppressed T1-weighted sequences. • Diaphragmatic lesions, mostly hyperintense nodules, are right-sided and predominantly posterior. • MRI can help in timely diagnosis of diaphragmatic endometriosis.
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Affiliation(s)
- Pascal Rousset
- Lyon 1 Claude Bernard University, Villeurbanne, France. .,Radiology Department, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France.
| | - Jules Gregory
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Biostatistics and Epidemiology department, Groupe Hospitalier Cochin Hôtel-Dieu, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Christine Rousset-Jablonski
- Obstetric and Gynecologic Department, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France
| | - Justine Hugon-Rodin
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Gynecology Endocrinology Department, Groupe Hospitalier Cochin Hôtel-Dieu, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Jean-François Regnard
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Thoracic Surgery Department, Groupe Hospitalier Cochin Hôtel-Dieu, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Charles Chapron
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Obstetric and Gynecologic Department, Groupe Hospitalier Cochin Hôtel-Dieu, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Joël Coste
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Biostatistics and Epidemiology department, Groupe Hospitalier Cochin Hôtel-Dieu, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - François Golfier
- Lyon 1 Claude Bernard University, Villeurbanne, France.,Obstetric and Gynecologic Department, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France
| | - Marie-Pierre Revel
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Radiology Department, Groupe Hospitalier Cochin Hôtel-Dieu, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
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Centini G, Afors K, Murtada R, Argay IM, Lazzeri L, Akladios CY, Zupi E, Petraglia F, Wattiez A. Impact of Laparoscopic Surgical Management of Deep Endometriosis on Pregnancy Rate. J Minim Invasive Gynecol 2016; 23:113-9. [DOI: 10.1016/j.jmig.2015.09.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/11/2015] [Accepted: 09/16/2015] [Indexed: 10/23/2022]
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Endometriosis Fertility Index ou classification de l’American Society of Reproductive Medicine pour les patientes infertiles endométriosiques opérées. Lequel est le plus pertinent ? ACTA ACUST UNITED AC 2015; 43:806-9. [DOI: 10.1016/j.gyobfe.2015.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 10/12/2015] [Indexed: 11/18/2022]
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Abrao MS, Petraglia F, Falcone T, Keckstein J, Osuga Y, Chapron C. Deep endometriosis infiltrating the recto-sigmoid: critical factors to consider before management. Hum Reprod Update 2015; 21:329-39. [DOI: 10.1093/humupd/dmv003] [Citation(s) in RCA: 237] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/06/2015] [Indexed: 12/15/2022] Open
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