EP24.07: Transvaginal ultrasound follow‐up of pelvic endometriosis according to #Enzian classification in women undergoing medical treatments

We aimed to evaluate the changes of pelvic endometriosis by transvaginal ultrasound (TVS), over a period of at least 24 months, using #Enzian classification in women who were managed only by medical treatment, without previous surgery. We included women with pelvic endometriosis diagnosed by TVS and classified according to #Enzian classification (compartments A,B, C,O,T,FA,FB,FI,FU,FO). All patients underwent clinical and ultrasound examinations at baseline and every 6 months for at least 24 months. All patients with TVS signs of endometriosis underwent continuous hormone therapy and during every follow-up visit all symptoms and all possible locations of endometriosis were assessed and recorded using #Enzian classification. 86 patients with ultrasound signs of endometriosis were enrolled; the mean follow-up period was of 31.6 ± 2.1 months. During follow-up, all patients showed a significant reduction in symptoms. Dysmenorrhea and heavy menstrual bleeding (HMB) were no longer detected and chronic pelvic pain was significantly reduced as early as the first 12-month follow-up as well as dyspareunia. At baseline we had 40/86 (46.5%) O1, 42/86 (48.8%) O2, whereas no O3 lesions were detected. At 24 months follow-up we observed a statistically significant decrease in O2 localization compared to baseline (42/86, 48.8% vs 8/82, 9.8%, p = 0.003) and in a consequent increase in endometriomas classifiable as O1 (40/86, 46.5% vs 56/82, 68.3%, p = 0.0005). Moreover, we did not see at TVS follow-up, endometriomas in 21.9% (18/82) of patients. Among patients with B localizations, 60 (76.9%) were B1, 18 (23.1%) were B2, whereas no B3 lesion was seen. This compartment did not show any significant change from baseline to 24 months follow-up. Similar results were observed in A,C,T and FA compartment. TVS evaluation of endometriosis using #Enzian classification could allow to monitor lesions progression in patients undergoing medical treatments; #Enzian compartments do not show great changes during follow-up, except for O compartment.