{"paper_id":"03138ad7-120b-440e-8f91-16416fb6e1ef","body_text":"Open Journal of Obstetrics and Gynecology, 2023, 13, 767-774 \nhttps://www.scirp.org/journal/ojog \nISSN Online: 2160-8806 \nISSN Print: 2160-8792 \n \nDOI: 10.4236/ojog.2023.134065  Apr. 28, 2023 767 Open Journal of Obstetrics and Gynecology \n \n \n \n \nThe Interest of Endoscopy in the Diagnosis of \nFallopian Tubes Diseases at the Yaoundé \nGyneco-Obstetric and Pediatric Hospital \n(Ygoph) \nCyrille Léger Abega1*, Claude Cyrille Noa Ndoua2, Irène Nadine Kouna Tsala3, Arielle Fonkou2, \nGladys Ngono Ateba4, Tobie Eric Ntsobe5, Jean Cédric Fouda2, Rosine Mafoma2, Pascal Foumane2 \n1Mother and Child Center, Douala General Hospital, Douala, Cameroon \n2Department of Gyneco-Obstetrics, Faculty of Medicine and Biomedical Sciences,  \nUniversity of Yaoundé I, Yaoundé, Cameroon \n3Department of Surgery, Protestant University of Central Africa (UPAC), Yaoundé, Cameroon \n4Faculty of Medecine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon \n5Garoua General Hospital, Garoua, Cameroon \n \n \n \nAbstract \nIntroduction: Fallopian diseases are often implicated in female infertility. \nSeveral radiological and surgical explorations have been proposed in order to \nevaluate the severit y of lesions found in utero -adnexal pathology. Among \ntools that are used to investigate such pathologies, we have ultrasound, hy s-\nterosalpingography and  endoscopy. But, in many developing countries like \nCameroon, the usage of endoscopy in gynecology is not yet known by many \npracticians. The objective of our study was to show the interest of endoscopy \nin the diagnosis of fallopian tube pathologies.  Methodology: We conducted a \ncross-sectional and descriptive study from March 1st, 2017 to May 31st, 2017 at \nthe Gyneco-Obstetrics and Pediatric department of our Hospital. We included \nall women who presented infertility and underwent ultrasound, hysterosalpin-\ngography (HSG) and endoscopy at the Yaoundé Gyneco-obstetrics Hospital. We \nanalyzed epidemiological parameters, clinics, ultrasound, hysterosalpingography \nand endoscopic finding. We used Cohen’s Kappa test to determine the correla-\ntion between HSG/endoscopy and ultrasound/endosco py in the diagnosis of \nfallopian tube pathologies. The threshold was significant for a K -value > 0.20. \nResults: We got a sample of 156 women; the mean age was 32.6  ± 4.5 years. \nThe Secondary infertility dominated in 66.7% of cases; 31.1% of women pr e-\nsented a past medical history of sexual ly transmitted infections and 41.7% did \nabortions before. Endoscopic lesions were dominated by a fallopian obstruc-\nHow to cite this paper: Abega, C.L., Noa \nNdoua, C.C., Kouna Tsala, I.N., Fonkou, \nA., Ngono Ateba, G., Ntsobe, T.E., Fouda, \nJ.C., Mafoma, R. and Foumane, P.  (2023) \nThe Interest of Endoscopy in the Diagnosis \nof Fallopian Tubes Diseases at the Yaoundé \nGyneco-Obstetric and Pediatric Hospital \n(Ygoph). Open Journal of Obstetrics and \nGynecology, 13, 767-774. \nhttps://doi.org/10.4236/ojog.2023.134065 \n \nReceived:  March 9, 2023 \nAccepted: April 25, 2023 \nPublished: April 28, 2023 \n \nCopyright © 2023 by author(s) and  \nScientific Research Publishing Inc. \nThis work is licensed under the Creative \nCommons Attribution International  \nLicense (CC BY 4.0). \nhttp://creativecommons.org/licenses/by/4.0/   \n  \nOpen Access\n\nC. L. Abega et al. \n \n \nDOI: 10.4236/ojog.2023.134065 768 Open Journal of Obstetrics and Gynecology \n \ntion in 54.5% of cases, 8.3% of adhesions, 33.9% of women prese nted uterine \nmyomas, 37.8% of ovarian cysts and 1.3% of pelvic endometriosis. The K-values \nbetween HSG and endoscopy for distal and prox imal tube obstructions were \nsignificant with respective thresholds of 0.25 and 0.30. The K- value between \nultrasound and endoscopy was not significant with a threshold of 0.015 for \nthe tubal hydrosalpinx. Conclusion:  Endoscopy assessment appears as the \nmost efficient tool to investigate fallopian tube diseases. \n \nKeywords \nFallopian Tube, Endoscopy, Hysterosalpingography, Ultrasound \n \n1. Introduction \nFallopian tube diseases have a great responsibility in the development of female \ninfertility. Many tools are used to investigate these pathologies such as ultr a-\nsound, hysterosalpingography and endoscopy. Out of interventional proposes in \nsurgery, endoscopy is a new technology that is also used for diagnostic i nvestiga-\ntions. It allows direct visualization of tissues and appears less invasive than other \nradiologic assessments. Current authors are considering endoscopy as the “gold \nstandard” to explore gynecologic roots [1]. Since the 20th century, endoscopy has \nbeen used in Europe and US for explorations and interventions in urology, g y-\nnecology gastroenterology and ENT. This new technology is gradually impo rted \ntowards developing countries.  In Sub -Saharan Africa, the implementation of \nendoscopy in the practice is in  process. Some countries like Cameroon intr o-\nduced endoscopy in 1992, Senegal in 1995 and Côte d ’Ivoire in 1999 [2]. But, \nmany gynecologists have not yet added endoscopic explorations to their practice. \nThis may be due to their ignorance or the lack of equipment. We have been moti-\nvated to conduct this study that aimed to demonstrate the interest of endoscopy in \nthe diagnosis of fallopian tube diseases at the Yaoundé Gyneco-Obstetrics and Pe-\ndiatrics Hospital (YGOPH) compared to HSG and ultrasound. \n2. Patients and Method \nThis study has been approved by the E thical Committee of the Yaoundé  Gyne-\nco-Obstetric and Pediatrics Hospital where the research has been conducted.  \nThe method was carried out in accordance with relevant guidelines and regul a-\ntions. An informed consent was obtained fr om each patient that we followed \nprospectively for participation in the study. We co nducted consecutive and e x-\nhaustive sampling. Thus, any patient followed at YGOPH during the study p e-\nriod and meeting our inclusion criteria was recruited. We conducted a 3 month \ncross-sectional and descriptive study from March 1 st, 2017 to May 31 st, 2017 at \nthe Yaoundé Gyneco-Obstetrics and Pediatric Department of  the YGOPH. We \nstudied the period of January 1 st, 2004 to December 31 st, 2016 and we included \nall women who presented infertility and underwent ultrasound, HSG and e n-\n\nC. L. Abega et al. \n \n \nDOI: 10.4236/ojog.2023.134065 769 Open Journal of Obstetrics and Gynecology \n \ndoscopy at the YGOPH. Gynecologic ultrasound was performed by abdominal \nor vaginal root.  We used ultrasound fr om 3.5 to 9 MHz, and a classic HSG was \nrealized. We used a 4F or 5F catheter to flow the contrast agent inside fallopian \ntubes and an X-ray film was realized to appreciate the vacuity of fallopian tubes. \nLaparoscopy was performed with a rigid endoscope for a trans- uterine visualiza-\ntion of fallopian tubes and other adnexia of the uterus . Data were collected from \npatient files where we retrieved US, HSG and post operative reports. The info r-\nmation collected were the age of patients, gynecologic and surgical past medical \nhistory, US, HSG and endoscopic findings with a type of surgery realized.  The \nCohen’s Kappa test was used to determine the correlation between HSG/endoscopy \nand ultrasound/endoscopy in the diagnosis of fallopian tube pathologies. The \nthreshold was significant for a K -value >  0.20. Data were analyzed with SPSS \nversion 21.0, Epi info version 5.1, and Microsoft Excel 2010. \n3. Results \n156 women met inclusion criteria in our study. The mean age was 32.6 ± 4.9 years \nwith extremities between 21 and 46 years. The modal group was represented by \nwomen aged between 30 and 35 years ( Table 1 ). The past medical history of v o-\nluntary interruption of pregnancy was found in 41.7%  of cases. 32.1% of patients \nsuffered from sexually transmitted infections and were recognized to have u n-\nprotected sexual intercourses. In additio n, 7.1% of women presented myomas \nand 1.3% ovarian cysts. 7.1% of women underwent myomectomy before; 3.8% \nunderwent salpingectomy and 3.2% tubal plastic surgery indicated for ectopic \npregnancy ( Table 2 ). HSG assessment revealed 29.8% of bilateral distal tubal \nobstructions, 16% of bilateral proximal tubal obstructions, 10.9% of unilateral dis-\ntal tubal obstructions, and 20.5% of unilateral proximal tubal obstructions (Table 3).  \n \nTable 1. Distribution of women according to socio-demographic characteristics N = 156. \nVariables  Effective  Percentage (%)  \nAge groups (years) <25 8 5.1 \n [25 - 30[ 32 20.5 \n [30 - 35[ 60 38.5 \n [35 - 40[ 46 29.5 \n [40 and +[ 10 6.4 \nMarital status Bride 90 57.7 \n Bachelor 66 42.3 \nOccupation Private sector 16 10.3 \n Public sector 37 23.7 \n Small trades 92 59.0 \n Student 10 6.4 \n Household 1 0.6 \n\nC. L. Abega et al. \n \n \nDOI: 10.4236/ojog.2023.134065 770 Open Journal of Obstetrics and Gynecology \n \nTable 2. Distribution of women according to the results of the anamnesis N = 156. \nVariables  Effective  Percentage (%)  \nGynecological history Abortion 65 41.7 \nsexually transmitted infection 50 32.1 \nPast history of dysmenorrhea 37 23.7 \nDyspareunia 36 23.1 \nTubo ovarian abscess 2 1.3 \nGynecological pathologies Myomas 11 7.1 \nSurgical history Ovarian cysts 2 1.3 \nMyomectomy 11 7.1 \nSalpingectomy 6 3.8 \ntubal plastic surgery 5 3.2 \ncaesarean section 3 1.9 \nCystectomy 1 0.6 \n Appendectomy 6 3.8 \n \nTable 3. Distribution of women according to the level of tubal obstruction (TO) N = 156. \nObserved lesions  Effective  Percentage(%)  \nBilateral Distal TO 47 29.8 \nUnilateral Proximal TO 32 20.5 \nBilateral Proximal TO 25 16.0 \nUnilateral Distal TO 22 10.9 \nIsthmic TO 3 1.9 \n \nTable 4. Distribution of women according to lesions found on ultrasound N = 62. \nVariables  Effective  Percentage (%)  \nUterine myomas 27 17.3 \nOvarian cysts 19 12.2 \nOvarian dystrophy 9 5.8 \nChronic adnexitis 3 1.9 \nHydrosalpinx 4 2.5 \n \nUterine myomas were found in 17.3% cases with ultrasound examination ( Table \n4). Endososcopic explorarations found myomas in 33.9% cases, 37.8% of corpus \nluteum cysts and Hydrosalpinx associated to tubal adhesions were diagnosed in \n58.3% of patients ( Table 5 ). The Cohen’s Kappa test for the correlation between \nHSG and laparoscop y was significant with a value of 0.36 for tubal obstructions \n(Table 6 ) and the correlation between ultrasound and endoscopy was no  signif-\nicant with a value of 0.015 for hydrosalpinx (Table 7 ) [3] [4] [5]. \n\nC. L. Abega et al. \n \n \nDOI: 10.4236/ojog.2023.134065 771 Open Journal of Obstetrics and Gynecology \n \nTable 5. Distribution of women according to the different lesions observed on endoscopy \nN = 156. \nVariables  Effective  Percentage (%)  \nUterine lesions Myomas 53 33.9 \nOvarian lesions Ovarian cysts 59 37.8 \nAdhesions 28 17.9 \nOvarian dystrophy 11 7.1 \nUnvisualized ovaries 2 1.3 \nPyo ovary 1 0.6 \nTubal lesions Distal tubal obstructions 32 20.5 \nTubal adhesions 91 58.3 \nProximal tubal obstructions 53 34.0 \nampullary mass 3 1.9 \nEndometrial lesions Endometriosis 2 1.3 \n \nTable 6. Correlation between hysterosalpingography and endoscopy in tubal obstructions \n(OT) in general. \n \nLaparoscopy  \nTotal  Kappa  P-value  \nYes No \nHSG* \nYes 46 (29.5%) 61 (39.1%) 107 (68.6%) 0.360 0.000 \nNo 7 (4.5%) 42 (26.9%) 49 (31.4%)   \nTotal 53 (34.0%) 103 (66.0%) 156 (100.0%)   \nHSG*: hysterosalpingography. \n \nTable 7. Correlation between ultrasound and laparoscopy in hydrosalpinx. \n \nendoscopy  \nTotal  Kappa  P-value  \nYes No \nUltrasound \nYes 3 (1.9%) 3 (1.9%) 6 (3.9%) 0.015 0.554 \nNo 93 (59.6%) 57 (36.5%) 150 (96.1%)   \nTotal 96(61.5%) 60 (38.4%) 156 (100.0%)   \n4. Discussion \nThe mean age of our sample was 32.63  ± 4.92 years with a modal group ranged \nbetween 30 and 35 years. Mboudou et al. found a similar result in a study co n-\nducted at the YGOPH that presented  a mean age of 31.8  ± 4.9 years [6]. Mehdi \nKehila et al. conducted another study in Tunis and presented a mean age of 35.3 \nyears [7]. This can be explained by the delay engagement in a couple ’s life due to \nsocio-economic conditions where women are interested by long studies first b e-\nfore marriage. Many studies reported sexual ly transmitted infections and volu n-\n\nC. L. Abega et al. \n \n \nDOI: 10.4236/ojog.2023.134065 772 Open Journal of Obstetrics and Gynecology \n \ntary interruption of pregnanc y as major risk factors of infertility  [8] [9]. Belley \nPriso et al . showed that 65% of women who consult for infertility have a past \nmedical history of chlamydia trachomatis infection [10]. In a study conducted by \nTshabu agumon et al. in Benin in 2014, he reported that many patients present-\ning infertility unde rwent pelvic surgery for myomectomy  [11]. A similar result \nhas been found in our study. In 2013, Mboudou et al. found ectopic pregnancy \nas a major risk factor of infertility in a cohort of patients where the majority u n-\nderwent surgery for abnormal location of the fetus [6]. So myomectomy, volu n-\ntary inter ruption of pregnancy and sexual ly transmitted diseases lead to adh e-\nrence which will cause fallopian tube obstruction and results to infertility  [11]. \nFallopian obstructions appear as the main lesion observed in our patients. It has \nbeen diagnosed in 79.3% with HSG and 54.50% with Endoscopy. Ultrasound \nwas less sensitive for tubal obstruction detection in our sample.  But with endos-\ncopy we diagnosed 1.3% of endometriosis and 1.9% of ampullary masses. E n-\ndoscopy appears more specific than HSG.  In a series of 120 patients Medhi K e-\nhila et al. found endometriosis in 7% of cases and fallopian tube  obstructions in \n20% of women with endoscopy  [8]. This difference can be explained by the size \nof his series which was less than ours. Out of diagnostic proposes, e ndoscopy has \nbeen used for adhesiolysis in 85.3% of cases. We also performed tubal fimbrio p-\nlasty and neosalpingostomy respectively in 15.4% and 63.5% of cases using e n-\ndoscopy. A few years before in the same town, current authors used endoscopy \nfor intervention proposes in gynecology.  In a series presented by Mboudou et al. \nin 2013, he performed tubal adhesiolysis in 71.6% of cases [6]. Kasia et al. per-\nformed tubal adhesiolysis in 73.9% of women who consult for infertility. He re a-\nlized fimbrioplasty and neosalpi ngostomy respectively in 46% and 56% of cases. \nThis difference can be explained by the big size in their series respectively 415 \nand 402. We did the Cohen ’s kappa test and the correlation between HSG and \nendoscopy for tubal obstruction in general was 0.36. This result is sensitive and \nsimilar to what Mehdi et al. reported in his series that was 0.42  [8]. Our study \npresented a good correlation between HSG and endoscopy in the detection of \nproximal tubal obstructions with a Cohen ’s Kappa sensitivity of 0.30. Mehdi Ke-\nhila et al. reported also a significant K -value of 0.48  [8]. The treatment of tubal \nobstructions is well managed with endosco py and several techniques have been \npresented by many authors in the previous literature in order to limit sollicita-\ntion of IVF for patients who consult for infertility  [12] [13] [14]. Furthermore, \nno correlation was found between ultrasound and endoscopy for hydrosalpinx in \nour study. The relationship between hydrosalpinx and female in fertility is well \naccepted with a fairly high prevalence in our study. Although ultrasound is mainly \nused to diagnose adnexial masses such as ovarian cysts, we have been using also \nfor tubal perm eability nevertheless it is not specific  [15]. In total, we diagnosed \n(2.5%) of lesions. For hydrosalpinx, a non -significant correlation between ultr a-\nsound and endoscopy has been found in our study and the K -value was 0.015. \nThis study was limited by the sample size that was short compared to other st u-\ndies. The stu died period was also short and we did not do a post operative fo l-\n\nC. L. Abega et al. \n \n \nDOI: 10.4236/ojog.2023.134065 773 Open Journal of Obstetrics and Gynecology \n \nlow-up of patients to present a short term results of endoscopy usage. \n5. Conclusion \nEndoscopy appears as the mo st efficient tool to diagnose and treat fallopian tube \ndiseases. Although many gynecologists still lack experience in endoscopy usage \nin our country, they may either refer patients w ho consult for infertility to a re f-\nerence hospital for better management o r look for training to improve their \nskills in endoscopy. \nConflicts of Interest \nThe authors declare no conflicts of interest regarding the publication of this p a-\nper. \nReferences \n[1] Zorom, B. (1999) Hysterosalpingography and Utero -Adnexal Pathology at the S a-\nnou Souro National Hospital in Bobo Dioulasso (CHNSS): About 408 Cases Col-\nlected in One Year. Doctoral Thesis, Ouagadougou University, Ouagadougou. \n[2] Pallas, G., Simon, F., Chapuis, O. and Jancovici, R. (2000) Inguinal Hernia in Africa \nand Laparoscopy: Utopia or Realism? Medecine Tropicale: Revue du Corps de sante \ncolonial, 60, 3893-3894. \n[3] Kharmach, M. (2005) GEU and Interest of Diagnostic Laparoscopy. Series of 418 \nCases of Clinical Suspicion of EP. 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