Conservative treatment of deep infiltrating endometriosis: review of existing options

Abstract

Endometriosis with its estimated incidence rate of ∼7-10% of women of reproductive age is a disease with the wide spectrum of symptoms depending on form and localization of endometrial foci. One clinical form of endometriosis is deep infiltrating endometriosis (DIE), most difficult to manage and generating a lot of direct and indirect treatment costs. We search the literature from PubMed database to establish the role of conservative treatment of DIE. Randomised controlled trials are lacking but in experts opinion hormonal treatment should be the first-line treatment in DIE. After evaluation of pain or other symptoms, second-line therapy with GnRH analogs or danazol should be offered or minimally invasive surgery. Consensus is not made whether surgery is the best therapeutic treatment for affected patients. Strong depending on surgeon's experience conservative surgery should be offered if the total excision of DIE foci is possible, which is essential for a successful outcome. If available treatment options do not release pain associated with DIE, experimental treatment in clinical trials should be discussed with patients.

Symptom control after different duration of triptorelin treatment following conservative surgery for deep infiltrating endometriosis

“…[ 3 ] It greatly reduces the quality of life of patients, meanwhile it increases the difficulty of treatment and increases the financial burden of their families. [ 5 ]…”

The efficacy and safety of up to 24 weeks of triptorelin therapy following conservative surgery in patients with deep infiltrating endometriosis (DIE): a multicentre, prospective, non-interventional study in China

“…20 However, whether surgery is the best therapeutic option strongly depends on the experience of the attending surgeon and the probability of being able to achieve total excision of DIE foci. 10 A previous report suggested that conservative surgery should be offered if the total excision of DIE foci is possible. 10 Regarding the alleviation of pain, the benefits of surgery should always be balanced with the risk of intraoperative complications.…”

“…10 A previous report suggested that conservative surgery should be offered if the total excision of DIE foci is possible. 10 Regarding the alleviation of pain, the benefits of surgery should always be balanced with the risk of intraoperative complications. 21,22 For infertile women with DIE, whether to opt for in vitro fertilization (IVF) treatment or surgery first can be a dilemma.…”

“…Furthermore, of the three clinical forms, DIE is the most difficult to manage and is associated with high direct and indirect treatment costs. 10 Surgery is often the preferred treatment in cases of DIE and the effectiveness of conservative surgery in patients with DIE has been demonstrated. 11,12 However, complete removal of endometriosis lesions during surgery cannot be guaranteed, leaving the possibility that residual lesions may continue to grow and new lesions may develop.…”

“…14 Gonadotropin-releasing hormone agonists (GnRH-a) have been recommended as second-line therapies for improving symptoms. 10 Triptorelin is one of the most commonly used GnRH-a and has been demonstrated to improve the symptoms and fertility outcomes of patients with DIE. 15,16 Although multiple studies have shown that GnRH-a treatment after surgery can improve post-operative pain and may facilitate a reduction in the rate of symptom recurrence, [17][18][19] the effectiveness and optimal duration of GnRH-a treatment after surgery in DIE are still debated in China.…”