A new technique called catheter-based sclerotherapy, used for treating patients with endometriomas, was shown to be associated with better short-term clinical outcomes and well-preserved ovarian function in women, according to researchers in South Korea.
Their study, “Catheter-directed Sclerotherapy for Ovarian Endometrioma: Short-term Outcomes,” was published in the journal Radiology.
Endometriosis is a condition in which the lining of the uterus, called the endometrium, grows outside of the uterus.
Endometriosis can sometimes involve the ovaries. In this area, fluid-filled cysts called endometriomas may form. An ovarian endometrioma is a cystic mass that is lined with endometrial tissue and contains thick, dark fluid.
Removing the cysts surgically has been considered the standard treatment for ovarian endometriomas. But this technique is associated with an inevitable decline in ovarian function and can lead to infertility.
So surgeons developed another technique called needle-based sclerotherapy, which is a less-invasive option in which the surgeon inserts a needle into the cyst using ultrasound for visualization and then withdraws the fluid from the cyst into the needle. Finally, the cyst is washed with a solution of ethanol.
While needle-based sclerotherapy is beneficial for surgical outcomes, it does have some issues.
“Endometrial cyst content can be incredibly thick and sticky. A 16- or 18-gauge needle, which is commonly used for needle-directed sclerotherapy, is sometimes not large enough to completely evacuate the cyst,” study co-author Man-Deuk Kim, an MD and PhD and a professor at Severance Hospital, Yonsei University College of Medicine in Seoul, South Korea, said in a press release.
“This may reduce the efficacy of sclerotherapy and increase the possibility of needle displacement during aspiration,” he added.
In order to find a way to address this issue, researchers replaced the needle in the sclerotherapy technique with a catheter, which is a tube that is used for extracting fluid from cavities in the body.
Then, researchers aimed to retrospectively evaluate the effectiveness of catheter-directed sclerotherapy (CDS) in patients with primary or recurrent ovarian endometriomas.
Specifically, researchers studied 14 women from the ages of 20-44 with ovarian endometriomas.
Results collected after one year show that the cysts decreased in size from an average of 5.8 cm in diameter to 1.1 cm.
Also, during an average follow-up of 12.7 months, researchers found no recurrences of endometrioma.
Researchers also found no difference in levels of serum anti-Müllerian hormone (AMH), which is a measure of ovarian function. This result indicates catheter-based sclerotherapy is associated with well-preserved ovarian function.
There were no procedure-related complications. Outcomes were also good for patients with internal septation (division) within their cysts, which are more difficult for physicians because multiple compartments of septated cysts can be difficult to puncture with a needle.
Using catheter-based sclerotherapy, surgeons can manipulate the catheter to break down internal septations, leading to more effective treatment.
“In our study, the recurrence rate of catheter-directed sclerotherapy was 0 percent, which is very encouraging given that endometriomas measuring up to 13.5 centimeters in diameter or those that had internal septation were included in the study,” Kim said.
“With several technical advantages, [catheter-based sclerotherapy] seems to be a promising modification of [needle-based sclerotherapy] to manage ovarian endometrioma,” the authors concluded. “Moreover, ovarian reserve was well-preserved in patients who underwent CDS for endometriomas, which may contribute to future fertility.”
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