Sonography, CT, and MRI appearance of the Essure microinsert permanent birth control device

Radiological assessment of the placement of Essure® in order to reduce hysterosalpingography: Pelvic X-ray versus combined pelvic X-ray and ultrasound

OBJECTIVE

Three months after hysteroscopic sterilisation with Essure^®, a confirmation test is required to evaluate the correct location of the inserts. The test may be conducted using a pelvic ultrasound (2D or 3D) or an abdominal X-ray. Should the location not look satisfactory on these tests, a follow-up hysterosalpingography (HSG) would be required. The objective of our study is to assess whether the Essure^® 3-month confirmation test using a single X-ray or a combination of X-ray and ultrasound could reduce the use of HSG.

STUDY DESIGN

This retrospective study examined patients who underwent birth control Essure^® procedure between 2009 and 2015 in the Gynaecological Surgery Department at the Regional University Hospital Centre (CHRU) in Lille. We divided patients into two groups based on the imaging tests performed: single X-ray (2009-2010) versus X-ray and pelvic ultrasound (2014-2015). We then compared the results of the imaging tests and the use of HSG between the two groups.

RESULTS

One hundred and thirty-four patients were tested, of which 60 (44.8%) using a single X-ray and 74 (55.2%) using a combination of X-ray and ultrasound. We note that the combined X-ray/ultrasound test reduces significantly the number of HSG performed (26.7% versus 12.2%, P=0.04).

CONCLUSION

Compared to a single X-ray, the combination of X-ray and ultrasound enables to significantly limit the use of HSG.

Evaluation of tubal microinserts position using 3D ultrasound and pelvic X-ray

PURPOSE

To retrospectively compare three-dimensional ultrasonography (3D-US) and pelvic X-rays to assess the position of tubal sterilization microinserts.

MATERIAL AND METHODS

Forty-four patients who underwent tubal sterilization with Essure(®) microinserts in our institution were included. The microinserts'position was evaluated three months after the procedure using 3D-US and pelvic X-rays. Placement on 3D-US was binary categorized as correct or incorrect and the distance between the two devices was reported. The orientation and symmetric deployment of the microinserts and the distance between the proximal parts of the two devices was assessed on pelvic X-rays. Performance of 3D-US and pelvic X-ray were compared using Mac Nemar test. Comparison of the distance between the two devices measured on pelvic X-rays and 3D-US was made with the paired Student t test.

RESULTS

3D-US images showed microinserts in 93% (41/44). Eighty-six percent (38/44) were correctly positioned on 3D-US and 82% (36/44) on pelvic X-rays. No significant differences between the performances of the two imaging techniques were found. No significant differences for the distance between the two devices measured on pelvic X-ray and 3D-US was found.

CONCLUSION

3D-US is a simple, non-ionizing technique, which appears as a promising alternate technique to pelvic X-rays to assess the correct position of Essure(®) microinserts.

Multimodality imaging of the Essure tubal occlusion device

The Essure device is a permanent birth-control device, which is gaining popularity. The micro-inserts are composed of metallic elements that can be seen on radiography, computed tomography, ultrasound, and magnetic resonance imaging. Knowledge of the normal location and appearance of the Essure device will ensure appropriate patient care. The purpose of this review is to describe the Essure tubal occlusion device and illustrate its normal and abnormal appearance using various imaging methods.

Normal and abnormal images of intrauterine devices: Role of three-dimensional sonography

The purpose of this pictorial essay is to describe the diagnostic value of two-dimensional ultrasound (2DUS) and the additional information that three-dimensional ultrasound (3DUS) provides in the assessment of location, type and complications of IUDs.

Commonly encountered foreign bodies and devices in the female pelvis: MDCT appearances

OBJECTIVE

The objective of this article is to illustrate the MDCT appearances of several commonly encountered foreign bodies and devices in the female pelvis.

CONCLUSION

The presence of a foreign body or device in the female pelvis can be a potential source of confusion to radiologists, particularly to the inexperienced reader. Familiarity with the normal appearances and locations of these devices on MDCT allows their accurate identification and detection of associated complications.

Hysterosalpingogram: an essential examination following Essure hysteroscopic sterilisation

OBJECTIVES

The aim of this study was to describe our experience of imaging following hysteroscopic sterilisation with the Essure (Conceptus Inc., Mountain View, San Carlos, CA) microinsert, and to underline the importance of a carefully performed follow-up hysterosalpingogram (HSG) in the management of these patients.

METHODS

18 women underwent the procedure and all returned for follow-up HSG. A standard HSG technique was used and views were acquired to establish microinsert position and tubal occlusion.

RESULTS

In 16 of the 18 women, adequate microinsert positioning and bilateral tubal occlusion was present. In one woman, a unilateral microinsert occluded the fallopian tube, whereas the other fallopian tube was ligated with a clip. The final patient underwent two studies; both showed well-positioned microinserts but unilateral free spill from the right fallopian tube. There are no reported pregnancies thus far.

CONCLUSION

Essure sterilisation coils have a unique appearance when radiographed and are an effective means of permanently occluding the fallopian tubes. HSG is a rapid and safe method of confirming satisfactory placement and tubal occlusion. Non-HSG imaging techniques are suboptimal at detecting patent fallopian tubes and expose patients to the risk of an unwanted and potentially complicated pregnancy.

Optimal Use of 3D and 4D Transvaginal Sonography in Localizing the Essure® Contraceptive Device

Current protocol in the United States does not include sonographic imaging for assessing proper placement of the Essure ® microinsert coils. An alternative to the current requirement of hysterosalpingography for imaging the metallic coils is described using 3D and 4D multiplanar imaging. Studies showing the advantages of using optimal sonographic techniques over other imaging modalities are shown to be less invasive, simpler, and with fewer risks. A review of 3D and 4D sonography reveals advantages in imaging the Essure microdevices.This article explores optimum techniques for localizing the Essure microdevices with 3D and 4D transvaginal sonography.

Pregnancy Outcome After Transcervical Hysteroscopic Sterilization

BACKGROUND

Hysteroscopic, transcervical sterilization involves placement of microinserts in tubal ostia. As with any contraceptive method, pregnancy can occur. This case reports the outcome when pregnancy occurred after microinsert placement.

CASE

A multiparous woman presented at 16 weeks of gestation. Hysteroscopic sterilization was performed 2 years earlier, although a postprocedure hysterosalpingogram was not done to verify tubal occlusion. The patient had a normal-term pregnancy. Postpregnancy hysterosalpingogram revealed both microinserts were embedded in the uterine fundus and myometrium.

CONCLUSION

This case demonstrates how pregnancy can occur after hysteroscopic microinsert placement and details how it might be avoided.

Sonography, CT, and MRI appearance of the Essure microinsert permanent birth control device

OBJECTIVE

The purpose of this article is to describe the appearance and location of the Essure permanent birth control device on sonography, CT, and MRI.

CONCLUSION

The Essure device has a distinct appearance and typical location that allow it to be accurately identified on sonography, CT, and MRI scans.