{"paper_id":"ee96b95a-c113-4811-9d21-ee1fa96a0a0c","body_text":"Abstract\nPurpose\nTo evaluate the safety and clinical outcome of two-session catheter-directed sclerotherapy (CDS) with 99% ethanol in patients with endometrioma.\nMaterials and Methods\nThis prospective study was approved by the institutional review board with written informed consent obtained from all participants and was registered on clinicaltrial.gov. Consecutive patients with ovarian endometrioma between June 2020 and March 2023 were prospectively evaluated for two sessions of CDS. After successful transvaginal ultrasound-guided puncture of the endometrioma, the biopsy needle was exchanged for a 7- or 8.5-F catheter for aspiration and ethanol injection. The catheter was retained in situ for a second session the next day. Endometrioma volume was measured on ultrasound before and 1, 3, and 6 months after CDS, and volume reduction ratio (VRR) was calculated. Serum anti-Müllerian hormone (AMH) was measured before and 6 months after CDS to assess ovarian reserve.\nResults\nThirty-one endometriomas in 22 patients (mean age, 31.0 years; range, 19–44 years) were treated; 28 endometriomas were successfully treated with two-session CDS, while one session was incomplete in three endometriomas in three patients due to contrast medium leakage or pain. Minor procedure-related complications developed in four patients and resolved spontaneously before discharge on the same day of the second session. No recurrence was identified during follow-up. At the 6-month follow-up, the mean endometrioma diameter decreased from 5.5 ± 1.7 to 1.4 ± 0.9 cm (P < 0.001), and the serum AMH level was lowered without statistical significance (1.37 ± 0.96 ng/mL vs. 1.18 ± 0.92 ng/mL; P = 0.170). VRRs at 1, 3, and 6 months after CDS were 84.3 ± 13.7%, 94.3 ± 5.8%, and 96.4 ± 4.7%, respectively.\nConclusion\nTwo-session CDS with 99% ethanol is safe, feasible, and effective for treating endometrioma with the ovarian function well preserved.\nGraphical Abstract\nSimilar content being viewed by others\nReferences\nHsu AL, Khachikyan I, Stratton P. Invasive and noninvasive methods for the diagnosis of endometriosis. Clin Obstet Gynecol. 2010;53(2):413–9.\nCruz J, Behbehani S. Battle for the endometrioma treatment championship: does sclerotherapy have a shot at the title? Fertil Steril. 2022;117(5):1104.\nJenkins S, Olive DL, Haney AF. Endometriosis: pathogenetic implications of the anatomic distribution. Obstet Gynecol. 1986;67(3):335–8.\nRedwine DB. Ovarian endometriosis: a marker for more extensive pelvic and intestinal disease. Fertil Steril. 1999;72(2):310–5.\nHwang H, et al. Clinical evaluation and management of endometriosis: guideline for Korean patients from Korean society of endometriosis. Obstet Gynecol Sci. 2018;61(5):553–64.\nThiel PS, et al. The effect of hormonal treatment on ovarian endometriomas: a systematic review and meta-analysis. J Minim Invasive Gynecol. 2024.\nCranney R, Condous G, Reid S. An update on the diagnosis, surgical management, and fertility outcomes for women with endometrioma. Acta Obstet Gynecol Scand. 2017;96(6):633–43.\nDilek U, et al. Excision of endometriotic cyst wall may cause loss of functional ovarian tissue. Fertil Steril. 2006;85(3):758–60.\nUnlu C, Yildirim G. Ovarian cystectomy in endometriomas: combined approach. J Turk Ger Gynecol Assoc. 2014;15(3):177–89.\nMuzii L, et al. Second surgery for recurrent endometriomas is more harmful to healthy ovarian tissue and ovarian reserve than first surgery. Fertil Steril. 2015;103(3):738–43.\nKoo JH, et al. Comparison of the therapeutic efficacy and ovarian reserve between catheter-directed sclerotherapy and surgical excision for ovarian endometrioma. Eur Radiol. 2021;31(1):543–8.\nMiquel L, et al. Endometrioma ethanol sclerotherapy could increase IVF live birth rate in women with moderate-severe endometriosis. PLoS ONE. 2020;15(9):e0239846.\nAkamatsu N, et al. Ultrasonically guided puncture of endometrial cysts–aspiration of contents and infusion of ethanol. Nihon Sanka Fujinka Gakkai Zasshi. 1988;40(2):187–91.\nYazbeck C, et al. Ethanol sclerotherapy: a treatment option for ovarian endometriomas before ovarian stimulation. Reprod Biomed Online. 2009;19(1):121–5.\nHan K, et al. Catheter-directed sclerotherapy for ovarian endometrioma: short-term outcomes. Radiology. 2018;289(3):854–9.\nFrankowska K, et al. The efficacy and safety of transvaginal ethanol sclerotherapy in the treatment of endometrial cysts-a systematic review. Int J Mol Sci. 2024;25(2):1337.\nKafali H, et al. Management of non-neoplastic ovarian cysts with sclerotherapy. Int J Gynaecol Obstet. 2003;81(1):41–5.\nHuang L, et al. Changes in anti-mullerian hormone after ultrasound guided aspiration and ethanol sclerotic therapy of ovarian cyst. Taiwan J Obstet Gynecol. 2021;60(3):509–12.\nGuerriero S, et al. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the international deep endometriosis analysis (IDEA) group. Ultrasound Obstet Gynecol. 2016;48(3):318–32.\nBazot M, et al. Accuracy of transvaginal sonography and rectal endoscopic sonography in the diagnosis of deep infiltrating endometriosis. Ultrasound Obstet Gynecol. 2007;30(7):994–1001.\nKim JH, et al. 2017 thyroid radiofrequency ablation guideline: Korean society of thyroid radiology. Korean J Radiol. 2018;19(4):632–55.\nLee JK, et al. Therapeutic efficacy of catheter-directed ethanol sclerotherapy and its impact on ovarian reserve in patients with ovarian endometrioma at risk of decreased ovarian reserve: a preliminary study. J Minim Invasive Gynecol. 2022;29(2):317–23.\nHealey MA, et al. Complications in surgical patients. Arch Surg. 2002;137(5):611–7.\nMuzii L, et al. Histologic analysis of endometriomas: what the surgeon needs to know. Fertil Steril. 2007;87(2):362–6.\nYounis JS, et al. Endometrioma surgery-a systematic review and meta-analysis of the effect on antral follicle count and anti-Mullerian hormone. Am J Obstet Gynecol. 2022;226(1):33–51.\nKim GH, et al. Ultrasound-guided sclerotherapy for the treatment of ovarian endometrioma: an updated systematic review and meta-analysis. Eur Radiol. 2022;32(3):1726–37.\nCohen A, Almog B, Tulandi T. Sclerotherapy in the management of ovarian endometrioma: systematic review and meta-analysis. Fertil Steril. 2017;108(1):117–24.\nHsieh CL, et al. Effectiveness of ultrasound-guided aspiration and sclerotherapy with 95% ethanol for treatment of recurrent ovarian endometriomas. Fertil Steril. 2009;91(6):2709–13.\nWang LL, et al. Ultrasound-guided interventional therapy for recurrent ovarian chocolate cysts. Ultrasound Med Biol. 2011;37(10):1596–602.\nAlbanese G, Kondo KL. Pharmacology of sclerotherapy. Semin Intervent Radiol. 2010;27(4):391–9.\nAflatoonian A, Tabibnejad N. Aspiration versus retention ultrasound-guided ethanol sclerotherapy for treating endometrioma: a retrospective cross-sectional study. Int J Reprod Biomed. 2020;18(11):935–42.\nGarcia-Tejedor A, et al. Ethanol sclerotherapy versus laparoscopic surgery for endometrioma treatment: a prospective, multicenter, cohort pilot study. J Minim Invasive Gynecol. 2020;27(5):1133–40.\nFiala L, Bob P, Raboch J. Oncological markers CA-125, CA 19–9 and endometriosis. Medicine (Baltimore). 2018;97(51):e13759.\nMagalhaes JS, et al. Role of biomarkers CA-125, CA-15.3 and CA-19.9 in the distinction between endometriomas and ovarian neoplasms. Biomarkers. 2021;26(3):268–74.\nSuardi D, et al. Correlation of serum anti-mullerian hormone (AMH) level on ovarian volum ein women with endometrioma. Int J Gen Med. 2021;14:1–8.\nMartinez-Garcia JM, et al. Comparing the effects of alcohol sclerotherapy with those of surgery on anti-Mullerian hormone and ovarian reserve after endometrioma treatment. A prospective multicenter pilot cohort study. Eur J Obstet Gynecol Reprod Biol. 2021;259:60–6.\nGhasemi Tehrani H, et al. Ethanol sclerotherapy versus laparoscopic surgery in management of ovarian endometrioma; a randomized clinical trial. Arch Acad Emerg Med. 2022;10(1):e55.\nAcknowledgements\nWe sincerely thank all the patients for participating in this trial.\nFunding\nThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nConflict of interest\nThe authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.\nAdditional information\nPublisher's Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nSupplementary Information\nBelow is the link to the electronic supplementary material.\nRights and permissions\nSpringer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.\nAbout this article\nCite this article\nZeng, C.H., Cao, C.W., Shin, J.H. et al. Safety and Clinical Outcomes of Two-Session Catheter-Directed Sclerotherapy Using Ethanol for Endometrioma. Cardiovasc Intervent Radiol 47, 901–909 (2024). https://doi.org/10.1007/s00270-024-03700-5\nReceived:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s00270-024-03700-5","source_license":"CC0","license_restricted":false}