Ultrasound-guided sclerotherapy for the treatment of ovarian endometrioma: an updated systematic review and meta-analysis

Objective To determine the efficacy and safety of ultrasound (US)-guided sclerotherapy for the treatment of ovarian endometrioma through a systematic review and meta-analysis.

MEDLINE and EMBASE databases were searched for studies reporting outcomes in patients with endometrioma who were treated with US-guided sclerotherapy. Meta-analyses of recurrence, pain resolution, pregnancy, technical success, and complication rates were analyzed. Subgroup analyses were conducted regarding the indwelling time of sclerotherapy (≤ 10 min vs > 10 min).

Twenty-eight studies (1301 patients) were included. The pooled technical efficacy was 98.3%. The pooled estimates of recurrence, pain resolution, and pregnancy rate were 13.8%, 85.9%, and 37.6%, respectively. The pooled major complication rate was 1.7%. A sclerotherapy time > 10 min had a lower pooled recurrence rate than a time ≤ 10 min (11.2% vs 20.9%; p = 0.106). Direct comparisons showed that the recurrence rate was significantly lower with sclerotherapy > 10 min than with sclerotherapy ≤ 10 min (OR, 0.2; p = 0.015). Regarding pregnancy rates, sclerotherapy of > 10 min showed no significant difference compared with sclerotherapy of ≤ 10 min (35.9% vs 38.8%; p = 0.664). Direct comparisons with surgery showed that sclerotherapy increased the pregnancy rate compared with surgery (OR, 2.0; p = 0.042). There was no significant difference in AMH level before and after sclerotherapy (p = 0.951). There was no significant difference in major complication rates between sclerotherapy > 10 min and ≤ 10 min (p = 0.837).

US-guided sclerotherapy seems to be an effective and safe therapeutic option regarding recurrence, pain resolution, and pregnancy for patients with ovarian endometrioma. Key Points • US-guided sclerotherapy seems to be an effective and safe therapeutic option regarding recurrence, pain resolution, and pregnancy for patients with ovarian endometrioma. • Sclerotherapy of more than 10 min had a lower recurrence rate than sclerotherapy less than or equal to 10 min. There was no significant difference in major complication rates between sclerotherapy of > 10 min and ≤ 10 min. • Future randomized controlled trials are warranted to compare the outcomes of US-guided sclerotherapy with surgery. Similar content being viewed by others Abbreviations - AMH: - Anti-Müllerian hormone - ART: - Assisted reproductive technology - CDS: - Catheter-directed sclerotherapy - CI: - Confidence interval - OR: - Odds ratio - RCT: - Randomized controlled trial - US: - Ultrasonography

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Hum Reprod 29:400–412 De Cicco NA, Carfagna P, De Cicco NC, Scambia G, Marana R, De Cicco NF (2020) Laparoscopic ethanol sclerotherapy for ovarian endometriomas: preliminary results. J Minim Invasive Gynecol 27:1331–1336 Author information Authors and Affiliations Corresponding author Ethics declarations Guarantor The scientific guarantor of this publication is Ji Hoon Shin. Conflict of interest The authors declare no competing interests. Statistics and biometry No complex statistical methods were necessary for this paper. Informed consent Written informed consent was not required for this study because this study is a systematic review and meta-analysis. Ethical approval Institutional review board approval was not required because this study is a systematic review and meta-analysis. Methodology • Meta-analysis. • Performed at one institution. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Gun Ha Kim and Pyeong Hwa Kim contributed equally to this work and share the first authorship. Supplementary Information Below is the link to the electronic supplementary material. Rights and permissions About this article Cite this article Kim, G.H., Kim, P.H., Shin, J.H. et al. Ultrasound-guided sclerotherapy for the treatment of ovarian endometrioma: an updated systematic review and meta-analysis. Eur Radiol 32, 1726–1737 (2022). https://doi.org/10.1007/s00330-021-08270-5 Received: Revised: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00330-021-08270-5