La nouvelle classification de l’endométriose révisée selon #Enzian : finalement une nomenclature complète et efficace ?

In: Journal für Gynäkologische Endokrinologie/Schweiz · 2021 · vol. 24(2) , pp. 93–97 · doi:10.1007/s41975-021-00194-z · W3166132458
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The SEF group proposes an updated #Enzian classification for endometriosis to describe superficial, ovarian, and tubal lesions alongside deep infiltrating ones.

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This paper discusses the need for a comprehensive endometriosis classification that can capture both the presence and extent of superficial and deep infiltrating lesions, and it proposes a revised system based on #Enzian by the SEF German-speaking research foundation. The authors extend the older ENZIAN classification, which primarily described deep infiltrating endometriosis, by adding a macroscopic description of superficial peritoneal lesions as well as ovarian and tubal involvement, aiming to make the nomenclature more complete and reflective of surgical findings and fertility-relevant anatomy. A stated limitation is that, up to now, a complete classification describing both lesion depth categories at the same time has been lacking, motivating this work as a conceptual/nomenclature revision rather than presenting new clinical outcome data. This paper is centrally about endometriosis — it revises the #Enzian classification to provide a more complete system including superficial and deep lesion descriptors.

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Résumé Une classification de l’endométriose est nécessaire pour l’évaluation des futures études sur le pronostic et l’efficacité de la thérapie proposée pour cette pathologie hétérogène et encore méconnue. Il est aussi très important qu’elle soit proche de la réalité, par rapport à la chirurgie et la fertilité de la femme. Malheureusement, au moins jusqu’à aujourd’hui, il manque encore une classification complète qui puisse décrire en même temps la présence et l’étendue des lésions endométriosiques superficielles et profondes. Les auteurs du groupe germanophone de la Fondation de recherche sur l’endométriose (Stiftung Endometriose-Forschung – SEF) proposent de combler ce manque par une nouvelle classification révisée selon #Enzian, étant donné que l’ancienne classification décrit uniquement les lésions endométriosiques infiltrantes en profondeur. On propose d’étendre cette classification à une description macroscopique des lésions péritonéales superficielles, des ovaires et des trompes. Zusammenfassung Eine Klassifizierung der Endometriose, eine heterogene und noch wenig bekannte Pathologie, ist für die Evaluation künftiger Studien zur Prognose und Wirksamkeit der vorgeschlagenen Therapien dringlich erforderlich. Leider fehlt, zumindest bis heute, eine vollständige Einteilung, die die Lokalisation und das Ausmaß sowohl oberflächlicher und tief infiltrierender Läsionen beschreibt. Die Autoren der deutschsprachigen Stiftung Endometriose-Forschung (SEF) schlagen vor, diese Lücke mit einer neuen überarbeiteten Klassifikation nach #Enzian zu schließen. Hierbei wird die alte Enzian Klassifikation, welche die tief infiltrierende Endometriose beschreibt, um eine makroskopische Beschreibung oberflächlicher Peritonealläsionen, Eierstöcke und Eileiter ergänzt. Références Fuldeore MJ, Soliman AM (2017) Prevalence and symptomatic burden of diagnosed endometriosis in the United States: national estimates from a cross-sectional survey of 59,411 women. Gynecol Obstet Invest 82(5):453–461. https://doi.org/10.1159/000452660 Cullen TS (1920) The distribution of adenomyomas containing uterine mucosa. Arch Surg 1(2):215–283. https://doi.org/10.1001/archsurg.1920.01110020002001 Sampson JA (1927) Peritoneal endometriosis due to the menstrual dissemination of endometrial tissue into the peritoneal cavity. Am J Obstet Gynecol 14(4):422–469. https://doi.org/10.1016/S0002-9378(15)30003-X Giudice LC, Kao LC (2004) Endometriosis. Lancet 364(9447):1789–1799. https://doi.org/10.1016/S0140-6736(04)17403-5 Acosta AA, Buttram VC, Besch PK, Malinak LR, Franklin RR, Vanderheyden JD (1973) A proposed classification of pelvic endometriosis. Obstet Gynecol 42(1):19–25 The American Fertility Society (1979) Classification of endometriosis. Fertil Steril 32(6):633–634 Revised American Fertility Society classification of endometriosis (1985) Fertil Steril 43(3):351–352. https://doi.org/10.1016/s0015-0282(16)48430-x Revised American Society for Reproductive Medicine classification of endometriosis (1996) Fertil Steril 67(5):817–821. https://doi.org/10.1016/s0015-0282(97)81391-x Chapron C et al (2003) Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification. Hum Reprod 18(1):157–161. https://doi.org/10.1093/humrep/deg009 the members of the French Endometriosis Study Group (GEE), Tran DK, Belaisch J (2012) Is it time to change the ASRM classification for endometriosis lesions? Proposal for a functional FOATIaRVS classification. Gynecol Surg 9(4):369–373. https://doi.org/10.1007/s10397-012-0739-3 Keckstein J, Ulrich U, Possover M, Schweppe KW (2003) ENZIAN-Klassifikation der tief infiltrierenden Endometriose. Zentralbl Gynakol 125:291–291 Haas 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(5):1574–1578. https://doi.org/10.1016/j.fertnstert.2011.01.135 Haas D, Oppelt P, Shebl O, Shamiyeh A, Schimetta W, Mayer R (2013) Enzian classification: does it correlate with clinical symptoms and the rASRM score? Acta Obstet Gynecol Scand 92(5):562–566. https://doi.org/10.1111/aogs.12118 Di Paola V, Manfredi R, Castelli F, Negrelli R, Mehrabi S, Pozzi Mucelli R (2015) Detection and localization of deep endometriosis by means of MRI and correlation with the ENZIAN score. Eur J Radiol 84(4):568–574. https://doi.org/10.1016/j.ejrad.2014.12.017 Montanari E, Dauser B, Keckstein J, Kirchner E, Nemeth Z, Hudelist G (2019) Association between disease extent and pain symptoms in patients with deep infiltrating endometriosis. Reprod Biomed Online 39(5):845–851. https://doi.org/10.1016/j.rbmo.2019.06.006 Burla L et al (2019) The ENZIAN score as a preoperative MRI-based classification instrument for deep infiltrating endometriosis. Arch Gynecol Obstet 300(1):109–116. https://doi.org/10.1007/s00404-019-05157-1 Metzemaekers J et al (2020) EQUSUM: Endometriosis QUality and grading instrument for SUrgical performance: proof of concept study for automatic digital registration and classification scoring for r‑ASRM, EFI and Enzian. Hum Reprod. https://doi.org/10.1093/hropen/hoaa053 Adamson GD, Pasta DJ (2010) Endometriosis fertility index: the new, validated endometriosis staging system. Fertil Steril 94(5):1609–1615. https://doi.org/10.1016/j.fertnstert.2009.09.035 Vesali S, Razavi M, Rezaeinejad M, Maleki-Hajiagha A, Maroufizadeh S, Sepidarkish M (2020) Endometriosis fertility index for predicting non-assisted reproductive technology pregnancy after endometriosis surgery: a systematic review and meta-analysis. BJOG 127(7):800–809. https://doi.org/10.1111/1471-0528.16107 Keckstein J, Saridogan E, Ulrich UA, Sillem M, Oppelt P, Schweppe KW, Krentel H, Janschek E, Exacoustos C, Malzoni M, Mueller M, Roman H, Condous G, Forman A, Jansen FW, Bokor A, Simedrea V, Hudelist G (2021) The #Enzian classification: a comprehensive non-invasive and surgical description system for endometriosis. Acta Obstet Gynecol Scand. https://doi.org/10.1111/aogs.14099 Author information Authors and Affiliations Corresponding author Ethics declarations Conflict of interest A. Fruscalzo, M. Stochino, N. Pluchino, J. bouquet de Jolinière et A. Feki déclarent ne pas avoir de conflit d’intérêt. Pour cet article, les auteurs n’ont réalisé aucune étude sur les humains ou les animaux. Les études réalisées étaient conformes aux normes éthiques indiquées dans chaque cas. Additional information Note de l‘éditeur Springer Nature conserve une position neutre en ce qui concerne les revendications juridictionnelles dans les cartes géographiques et les affiliations institutionnelles figurant dans ses publications. Rights and permissions About this article Cite this article Fruscalzo, A., Stochino, E., Pluchino, N. et al. La nouvelle classification de l’endométriose révisée selon #Enzian : finalement une nomenclature complète et efficace ?. J. Gynäkol. Endokrinol. CH 24, 93–97 (2021). https://doi.org/10.1007/s41975-021-00194-z Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s41975-021-00194-z

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