{"paper_id":"6ba3d4bc-6861-46df-a97f-c6ae0f2c10df","body_text":"Posted on 2 May 2025 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.174616570.09691073/v1 — This is a preprint and has not been peer-reviewed. Data may be preliminary.\nUltrasound-Guided Ethanol Sclerotherapy versus Laparoscopic\nSurgery for Endometriomas: As-Treated Analysis of a Pragmatic\nRandomized Clinical Trial\nAmparo Garcia-Tejedor1, Rodrigo Guevara-Peralta1, Jose Manuel Martinez-Garcia 1,\nShiana Corbal´ an2, Mauricio Ag¨ uero3, Maria Gomez-Romero 4, Marta Cararach5, Marta\nCastellarnau6, MARIA VICTORIA RODRIGUEZ-GALLEGO 7, Ana Cristina\nLou-Mercad´ e8, Laura Costa 9, Maria Jose Rodr´ ıguez10, Eva Huguet-Galofr´ e11, Manuel\nCarreras12, Ana Belen Castel-Segui 13, Maria Font-Roig14, Susana Royo15, Nuria Sarasa 16,\nBeatriz Candas17, Samuel Perez-Carton1, Carlos Ortega 1, Maria Jesus Pla 1, and Jordi\nPonce-Sebastia1\n1Universitat de Barcelona Facultat de Medicina i Ciencies de la Salut\n2Hospital General Universitario Los Arcos del Mar Menor\n3Hospital del Mar Servei de Obstetricia i Ginecologia\n4Hospital Universitari de Tarragona Joan XXIII\n5Hospital de Viladecans\n6Consorci Sanitari de Barcelona\n7Hospital San Pedro\n8Hospital Clinico Universitario Lozano Blesa\n9Consorcio Corporacion Sanitaria Parc Tauli\n10Hospital Universitario Central de Asturias\n11Fundacio Assistencial de Mutua de Terrassa FPC\n12Parc Sanitari Sant Joan de Deu Hospital General\n13Hospital Universitario Son Espases\n14Hospital Santa Caterina\n15Fundacion de Investigacion del Hospital General Universitario de Valencia\n16Hospital General de Granollers\n17Institut d’Investigacio Biomedica de Bellvitge\nMay 02, 2025\nAbstract\nObjective: To compare the efficacy of ultrasound-guided alcohol sclerotherapy versus laparoscopic cystectomy for the manage-\nment of ovarian endometriomas, focusing on complications, recurrence, pain relief, and healthcare costs. Design: Multicentre,\nrandomised clinical trial. Setting: Twenty secondary and tertiary endometriosis referral centres across Spain. Population: A\ntotal of 207 women aged 18–40 years with ovarian endometriomas (35–100 mm in diameter) recruited between February2016-\nJune2022. Patients with extraovarian endometriosis or adenomyosis requiring surgical treatment were excluded. Methods:\nParticipants were randomised to either ultrasound-guided aspiration & alcohol sclerotherapy or standard laparoscopic cystec-\ntomy. Complications were assessed using the Clavien-Dindo classification. Pain was measured via a visual analogue scale.\nRecurrence was defined as the reappearance of a cyst at the treated site and analysed using Kaplan–Meier estimates. The study\n1\n\nPosted on 2 May 2025 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.174616570.09691073/v1 — This is a preprint and has not been peer-reviewed. Data may be preliminary.\nwas conducted as a treated cohort of 155 patients (sclerotherapy: n=89; cystectomy: n=66). Direct hospital costs were also\nanalysed. Main Outcome Measures: Complication rate, recurrence rate, pain relief, and direct treatment costs. Results:\nBoth groups had a complication rate of around 15%, with grade III complications occurring in 1.1% of the sclerotherapy group\nand 4.5% of the surgery group. Recurrence rates were similar (19.1% sclerotherapy vs. 21.2% cystectomy, p=0.84). Pain relief\nwas similar in both groups (87% vs. 81%). The cost of sclerotherapy was significantly lower (EU276 vs. EU2,348, p <0.001).\nConclusions: Ultrasound-guided alcohol sclerotherapy is a safe, cost-effective alternative to laparoscopic cystectomy for the\ntreatment of endometriomas, with comparable recurrence rates and pain relief. F unding: A grant from Carlos III Health\nInstitute (PI16/00801).\nHosted file\nMain text_as treated.docx available at https://authorea.com/users/919588/articles/1291903-\nultrasound-guided-ethanol-sclerotherapy-versus-laparoscopic-surgery-for-endometriomas-\nas-treated-analysis-of-a-pragmatic-randomized-clinical-trial\nHosted file\nFigure 2_CONSORT Flow Diagram_as treated_v2.doc available at https://authorea.com/users/\n919588/articles/1291903-ultrasound-guided-ethanol-sclerotherapy-versus-laparoscopic-\nsurgery-for-endometriomas-as-treated-analysis-of-a-pragmatic-randomized-clinical-trial\nHosted file\nFigures_3_recurrences and follow-up_as treated.docx available at https://authorea.com/users/\n919588/articles/1291903-ultrasound-guided-ethanol-sclerotherapy-versus-laparoscopic-\nsurgery-for-endometriomas-as-treated-analysis-of-a-pragmatic-randomized-clinical-trial\nHosted file\nTables_as treated.docx available at https://authorea.com/users/919588/articles/1291903-\nultrasound-guided-ethanol-sclerotherapy-versus-laparoscopic-surgery-for-endometriomas-\nas-treated-analysis-of-a-pragmatic-randomized-clinical-trial\nHosted file\nCONSORT 2010 Checklist_1.doc available at https://authorea.com/users/919588/articles/1291903-\nultrasound-guided-ethanol-sclerotherapy-versus-laparoscopic-surgery-for-endometriomas-\nas-treated-analysis-of-a-pragmatic-randomized-clinical-trial\n2","source_license":"CC0","license_restricted":false}