Sclerotherapy with Ethanol: An Effective and Safe Alternative to Potentially Complex Surgical Treatment of Recurrent Ovarian Endometrioma

Abstract

Objective The aim of this study was to evaluate the efficacy and safety of transvaginal ultrasound guided aspiration of ovarian endometrioma and ethanol sclerotherapy before controlled ovarian hyperstimulation (COH) and intrauterine insemination (IUI) or assisted reproductive technology (ART) in patients with recurrent ovarian endometrioma. Design Prospective study. Setting Infertility Care and Research Center (ICRC Pvt Ltd.), Dhaka, Bangladesh. Materials and methods Fifty-three patients with infertility and recurrent ovarian endometrioma were the target population of this study. Sclerotherapy was performed under sedation (Pethidine) or G/A (propofol) and transvaginal ultrasound guidance. An 16-guage, double-lumen needle was inserted into the endometrioma and the cyst contents were sequentially aspirated and flushed with sterile saline until the aspirated fluid was clear. Ninety-five percent ethyle alcohol (ethanol) was then instilled into the cyst and kept in situ. Ultrasound was performed 6 weeks, 3, 6 and 12 months later to assess the efficacy of treatment. Controlled ovarian hyperstimulation and IUI or ART was performed according to patients’ profile and desire. Main outcome measures Resolution and recurrence of endometrioma and pregnancy rate. Results Thirty-nine patients had unilateral, 14 had bilateral, 36 had single and 17 had more than one cysts. Size of the cysts were 3.5 to 10 cm, average 6.75 ± 1.64 cm. Complete resolution of cyst took place in 42 (79.25%) cases. Eleven patients had persistence and refilling of cyst. Four of them needed reaspiration. No complications developed in any case. Thirty patients (52 cycles) underwent COH and IUI and 5 (16.57%) of them got pregnant. Forty-one patients underwent ART (63 cycles) and 13 (31.71%) got pregnant. Six (11.32) patients developed small cyst <3 cm within 1 year during the course of treatment. Conclusion Sclerotherapy with 95% ethanol is a simple, effective and safe alternative to surgical intervention for treatment of recurrent ovarian endometriomas before COH and IUI or ART. How to cite this article Begum M R, Ehsan M, Ehsan N, Santa MSB, Khan F, Sharmin F. Sclerotherapy with Ethanol: An Effective and Safe Alternative to Potentially Complex Surgical Treatment of Recurrent Ovarian Endometrioma. J South Asian Feder Obst Gynae 2015;7(2):97-101.

The Efficiency of Sclerotherapy for the Management of Endometrioma: A Systematic Review and Meta-Analysis of Clinical and Fertility Outcomes

“…Of those, 29 matched inclusion criteria and were included in the systematic review. A total of 21 of them were non-comparative, single-armed studies evaluating only sclerotherapy [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ]. The other eight studies were comparative studies between surgery and sclerotherapy and were included in quantitative analysis ( Figure 1 ) [ 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ].…”

“…Overall, the publication years ranged from 1997 to 2022 [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. In total, 1642 patients with endometriomas were included [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , ...…”

“…In total, 1642 patients with endometriomas were included [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. The follow-up (FU) period ranged from 1.5 to 84 months on average [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , …”

“…A total of 1642 patients were included in the review [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. Not all of the 29 selected studies presented data about clinical outcomes—SR, RR—and pregnancy outcomes—PR before and after the procedure.…”

“…Instilled volume ranged from 20% to 80% of the cyst fluid volume for 5–20 min or left in situ. Except for 12, other 17 studies presented SR data in sclerotherapy [ 18 , 19 , 20 , 21 , 22 , 24 , 26 , 27 , 29 , 30 , 31 , 33 , 35 , 36 , 39 , 41 ]. A total of 11 studies reported a 100% SR [ 19 , 21 , 22 , 24 , 29 , 30 , 31 , 35 , 36 , 39 , 43 ], 4 studies showed an SR > 80.0% [ 18 , 26 , 27 , 33 ], whereas only two studies had an SR < 80.0% [ 20 , 30 ], of which one consisted of tetracycline instillation [ 19 ].…”