{"paper_id":"83ce48d8-0b03-4b8a-93a4-ae51120170d5","body_text":"Abstract\nPurpose\nThe most widely accepted classification for endometriosis is the Revised American Society for Reproductive Medicine (rASRM) system, but this does not take deeply infiltrating endometriosis (DIE) into account. The Enzian classification enables clinicians to classify DIE. Due to complexity and partial overlap with rASRM, it was revised for a second time in February 2011. Using both the systems to classify lesions would be inappropriate, as they refer to different locations. The aim of this study was to analyze whether the revised Enzian classification is easier to use and avoids duplicate classifications.\nMethods\nRetrospective study of 460 women admitted for endometriosis.\nResults\nOne hundred and eighty-seven of 460 patients (41 %) had histologically confirmed DIE based on the revised Enzian classification. Further classification of these 187 patients using Enzian revealed 270 retroperitoneal lesions, as some patients had several DIE-type lesions simultaneously: 66 in compartment A (rectovaginal septum, vagina), 112 in compartment B (sacrouterine ligaments, pelvic wall), 58 in compartment C (bowel), 15 with adenomyosis uteri, 7 with bladder involvement, 8 with intrinsic involvement of the ureter, and 4 with bowel involvement. All 270 lesions were classified using Enzian alone and not with the rASRM score. There were no duplicate classifications (rASRM and Enzian).\nConclusions\nThe revised Enzian classification is an excellent complement to the rASRM score for morphological description of DIE.\nSimilar content being viewed by others\nAbbreviations\n- AFS:\n-\nAmerican Fertility Society\n- DIE:\n-\nDeeply infiltrating endometriosis\n- EFI:\n-\nEndometriosis fertility index\n- IRB:\n-\nInstitutional review board\n- rAFS:\n-\nRevised American Fertility Society (score)\n- rASRM:\n-\nRevised American Society for Reproductive Medicine (score)\nReferences\nSchweppe KW (2003) Endometriosis—a disease that has no lobby. Zentralbl Gynakol 125:233 (German)\nBurghaus S et al (2011) Risk factors for endometriosis in a German case-control study. Geburtsh Frauenheilk 71(12):1073–1079\nZimmermann A, Brandes I, Babitsch B (2010) Information needs of women with endometriosis within the scope of healthcare provision. Geburtsh Frauenheilk 70(7):568–573\nLockyer C (1918) A new classification of adenomyoma. In: Lockyer C (ed) Fibroids and allied tumours (myoma and adenomyoma): their pathology, clinical features and surgical treatment. Macmillan, London, pp 306–378\nAcosta AA, Buttram VC Jr, Besch PK, Malinak LR, Franklin RR, Vanderheyden JD (1973) A proposed classification of pelvic endometriosis. Obstet Gynecol 42:19–25\nAlbrecht H (1955) Die Endometriose. In: Seitz L, Amreich AI (eds) Biologie und Pathologie des Weibes: Ein Handbuch der Frauenheilkunde und der Geburtshilfe, vol 4, 2nd edn. Urban and Schwarzenberg, Berlin, pp 190–288\nThe American Fertility Society (1979) Classification of endometriosis. Fertil Steril 32:633–634\nThe American Fertility Society (1985) Revised American Fertility Society classification of endometriosis: Fertil Steril 43:351–352\nAmerican Society for Reproductive Medicine (1996) Revised American Society for Reproductive Medicine classification of endometriosis: Fertil Steril 67:817–821\nKubiak A, Dieterle S, Neuer A, Bierhals K, Greb R. Stadiengerechte Fertilitätseinschränkungen bei peritonealer und tief-infiltrierender Endometriose: Welche Mechanismen werden durch die in vitro Fertilisation erkennbar. Geburtsh Frauenheilk 2011 71\nAdamson GD, Pasta DJ (2010) Endometriosis fertility index: the new, validated endometriosis staging system. Fertil Steril 94:1609–1615\nTuttlies F, Keckstein J, Ulrich U, Possover M, Schweppe KW, Wustlich M et al (2005) ENZIAN-score, a classification of deep infiltrating endometriosis. Zentralbl Gynakol 127:275–281\nHaas D, Chvatal R, Habelsberger A, Wurm P, Schimetta W, Oppelt P (2011) Comparison of revised American Fertility Society and Enzian staging: a critical evaluation of classifications of endometriosis on the basis of our patient population. Fertil Steril 95:1574–1578\nStiftung Endometriose Forschung (2010) 6th Conference of the Stiftung Endometriose Forschung (Foundation for Endometriosis Research). Hotel Enzian, Weissensee, Austria, February 19–21, 2010\nStiftung Endometriose Forschung (2011) The revised Enzian classification. [Consensus meeting, 7th Conference of the Stiftung Endometriose Forschung (Foundation for Endometriosis Research), Hotel Enzian, Weissensee, Austria, February 25–27, 2011.] Weissensee, Austria: Stiftung Endometriose Forschung (SEF)\nMechsner S, Infanger M, Ebert AD, Schneider A, Bartley J (2010) Abdominal wall endometriosis—diagnosis and therapeutic management. Geburtsh Frauenheilk 70(3):207–214\nGardanis K et al (2010) Minimally invasive surgery for deep infiltrating endometriosis in the rectovaginal septum. Geburtsh Frauenheilk 70(3):194–200\nKoninckx PR, Martin DC (1992) Deep endometriosis: a consequence of infiltration or retraction or possibly adenomyosis externa? Fertil Steril 58(5):924–928\nAcknowledgments\nThe authors would like to thank the Medical Society of Upper Austria (Medizinische Gesellschaft für Oberösterreich) for providing support for this study.\nConflict of interest\nThe authors have stated explicitly that there are no conflicts of interest in connection with this article. None of the authors has received any financial support for this study, and the contents have not been presented previously at any meeting. Institutional review board (IRB) approval was obtained.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nAdditional information\nRegistration number of the ethical review committee, Linz, Austria, 2010: C-11-10 (2.1.7).\nRights and permissions\nAbout this article\nCite this article\nHaas, D., Wurm, P., Shamiyeh, A. et al. Efficacy of the revised Enzian classification: a retrospective analysis. Does the revised Enzian classification solve the problem of duplicate classification in rASRM and Enzian?. Arch Gynecol Obstet 287, 941–945 (2013). https://doi.org/10.1007/s00404-012-2647-1\nReceived:\nAccepted:\nPublished:\nIssue date:\nDOI: https://doi.org/10.1007/s00404-012-2647-1","source_license":"CC0","license_restricted":false}