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Knorren ER, de Ridder LA, Nijholt IM, Dijkstra JR, Braat MNGJA, Huirne JAF, Boomsma MF, Schutte JM. Effectiveness and complication rates of high intensity focused ultrasound treatment for abdominal wall endometriosis: A systematic review. Eur J Obstet Gynecol Reprod Biol 2024; 297:15-23. [PMID: 38555851 DOI: 10.1016/j.ejogrb.2024.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/02/2024]
Abstract
In this review, a systematic literature search on the effectiveness and complication rates of ultrasound-guided and magnetic resonance-guided high-intensity focused ultrasound (USg-/MRgHIFU) for abdominal wall endometriosis (AWE) was conducted in six databases in May/June 2023. Original articles of (non)randomized trials, cohort studies, case-control studies and case series published in peer-reviewed journals were included. Of the included studies the level of evidence (LoE) and methodological quality using the ROBINS-I and IHE-QAT was assessed. Primary outcomes were non-perfused volume ratio (NPV%), lesion size, pain scores, side effects and complication rates according to Society of Interventional Radiology (SIR) guidelines. Secondary outcomes were recurrence and re-intervention rates. Seven cohort studies (one of good methodological quality) (LoE 3) on USgHIFU were included (n = 212, AWE lesions = 240-245). Six months after USgHIFU treatment, pain scores were reduced with 3.3-5.2 points (baseline: 5.1-6.8, n = 135). Self-limiting side effects were pain (85.7 % (114/133)) and swelling (34.6 % (46/133)) in the treatment area. Complications occurred in 17.7 % (32/181), all of which were minor. Recurrence occurred in 12.8 % (11/86). Three of these seven cohort studies compared USgHIFU (n = 61) with surgical excision (n = 74). Pooled results showed no significant differences in pain scores, complications (resp. 26.3 % (10/38) vs. 32.6 % (15/46) (p = 0.53)) and recurrences (resp. 4.9 % (3/61) vs. 5.4 % (4/74) (p = 0.90)). This systematic review suggests that HIFU is an effective and safe treatment option for AWE. USgHIFU treatment led to reduced pain scores and lesion size, was free of major complications and had a pooled recurrence rate of 12.8 %. Compared to surgical excision pooled results showed no significant differences in pain scores, complications and recurrences after USgHIFU. However, many of the included studies had limitations in their methodological quality and therefore the results should be interpreted with caution. Well-structured high-quality randomized controlled trials comparing HIFU to standard care should be conducted to provide more conclusive evidence.
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Affiliation(s)
- Elisabeth R Knorren
- Department of Obstetrics and Gynecology, Isala Hospital, Dokter van Deenweg 2, 8025AB Zwolle, The Netherlands; Department of Radiology, Isala Hospital, Dokter van Deenweg 2, 8025AB Zwolle, The Netherlands.
| | - Larissa A de Ridder
- Department of Obstetrics and Gynecology, Isala Hospital, Dokter van Deenweg 2, 8025AB Zwolle, The Netherlands
| | - Ingrid M Nijholt
- Department of Radiology, Isala Hospital, Dokter van Deenweg 2, 8025AB Zwolle, The Netherlands
| | - Jeroen R Dijkstra
- Department of Obstetrics and Gynecology, Isala Hospital, Dokter van Deenweg 2, 8025AB Zwolle, The Netherlands
| | - Manon N G J A Braat
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584XC Utrecht, The Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centre, location VUmc, Amsterdam Research Institute, Reproduction and Development, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands
| | - Martijn F Boomsma
- Department of Radiology, Isala Hospital, Dokter van Deenweg 2, 8025AB Zwolle, The Netherlands; Imaging & Oncology Division, Image Sciences Institute, University Medical Center Utrecht, Heidelberglaan 100, 3584XC Utrecht, The Netherlands
| | - Joke M Schutte
- Department of Obstetrics and Gynecology, Isala Hospital, Dokter van Deenweg 2, 8025AB Zwolle, The Netherlands
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Allen SE, Rindos NB, Mansuria S. Abdominal wall endometriosis: an update in diagnosis, perioperative considerations and management. Curr Opin Obstet Gynecol 2021; 33:288-295. [PMID: 34054100 DOI: 10.1097/gco.0000000000000714] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE OF REVIEW Abdominal wall endometriosis (AWE) is rare with limited evidence guiding diagnosis and treatment. The purpose of this review is to provide an update of the diagnosis, perioperative considerations, and treatment of AWE. RECENT FINDINGS Recent studies further characterize presenting symptoms and locations of AWE. Prior abdominal surgery remains the greatest risk factor for the development of AWE. Newer evidence suggests that increasing BMI may also be a risk factor. Ultrasound is first-line imaging for diagnosis. Magnetic resonance image is preferred for surgical planning for deep or extensive lesions. Laparotomy with wide local excision is considered standard treatment for AWE with great success. Novel techniques in minimally invasive surgery have been described as effective for the treatment of AWE. A multidisciplinary surgical approach is often warranted for successful excision and reapproximation of skin and/or fascial defects. Noninvasive therapies including ultrasonic ablation or cryotherapy are also emerging as promising treatment strategies in select patients. SUMMARY Recent studies provide further evidence to guide diagnosis through physical exam and imaging as well as pretreatment planning. Treatment options for AWE are rapidly expanding with novel approaches in minimally invasive and noninvasive therapies now available.
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Affiliation(s)
- Sarah E Allen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania, USA
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