The first case of ethanol sclerotherapy in 1998. Management of recurrent endometriosis after TAH+BSO – report of three cases

Pratibha Devabhaktuni, Savitha Devi Yelamanchi, Mahjabeen Singh
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2026 · doi:10.18203/2320-1770.ijrcog20261480 · W7161549671
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This paper reports on the first use of ethanol sclerotherapy in 1998 to manage recurrent endometriosis after hysterectomy and bilateral salpingo-oophorectomy, but found it led to early recurrence in two other cases.

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This case report series describes three women with recurrent endometriosis and severe pain after total hysterectomy with bilateral salpingo-oophorectomy (TAH+BSO), focusing on ethanol sclerotherapy as a management approach between 1996 and 1998. Across the cases, pelvic endometriotic cysts were identified by scan after surgery, aspirated transvaginally, and ethanol was injected into the cyst; in at least one case danazol was also administered for three months. The paper reports that ethanol sclerotherapy was used to treat recurrent endometriotic cysts, but it also states a contrasting experience where estrogen-replacement therapy (ERT) resulted in early recurrence and should be avoided, alongside mention of danazol side effects. This paper is centrally about endometriosis — it reports three cases of ethanol sclerotherapy for recurrent endometriosis after TAH+BSO and discusses recurrence related to ERT.

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Abstract

The first case of Ethanol sclerotherapy (EST) in 1998. Management of Recurrent Endometriosis after TAH+BSO, three cases are presented. The objective is to bring to focus the pitiable plight of these women suffering from severe pain abdomen prior to surgery and again after surgery due to recurrent disease. The dilemma of the doctor in deciding the best possible method of managing these cases. To present the different methods adopted to alleviate the pain and treat recurrences three decades ago. To discuss the current management trends. Case Report 1: Mrs. L. 46 years P2 L2 was operated for stage IV endometriosis. TAH+BSO was done on 5.2.96. A scan was done on 27.7.97 revealed an endometriotic cyst in the pelvis, 4.9x4.8 cms and 40 ml of thick chocolate material was aspirated vaginally. Ethanol, 5 ml was injected in the cyst. By three months there was reformation of endometrioma and a repeat second aspiration was done. Danazol 400 mgs/day, in divided doses was given for three months. Two years after TAH+BSO, third time aspiration of 7 ml thick chocolate liquid was done from 2 cms cyst and 4 ml spirit, absolute alcohol was injected on 15.1.98. We present our first case of ethanol sclerotherapy to treat recurrent endometriotic cyst after hysterectomy and bilateral salpingo oophorectomy in 1996-1998. In two other cases ERT had resulted in early recurrence of endometriosis, hence should be avoided. Endometriosis being a recurrent disease, the management decisions had to be individualized. We have discussed about Ethanol sclero therapy, reasons for recurrence after TAH+BSO, and the side effects of Danazol.
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The first case of ethanol sclerotherapy in 1998. Management of recurrent endometriosis after TAH+BSO – report of three cases DOI: https://doi.org/10.18203/2320-1770.ijrcog20261480Keywords: Endometriosis recurrence, Ethanol sclerotherapy, ERT, Endometriotic cystAbstract The first case of Ethanol sclerotherapy (EST) in 1998. Management of Recurrent Endometriosis after TAH+BSO, three cases are presented. The objective is to bring to focus the pitiable plight of these women suffering from severe pain abdomen prior to surgery and again after surgery due to recurrent disease. The dilemma of the doctor in deciding the best possible method of managing these cases. To present the different methods adopted to alleviate the pain and treat recurrences three decades ago. To discuss the current management trends. Case Report 1: Mrs. L. 46 years P2 L2 was operated for stage IV endometriosis. TAH+BSO was done on 5.2.96. A scan was done on 27.7.97 revealed an endometriotic cyst in the pelvis, 4.9x4.8 cms and 40 ml of thick chocolate material was aspirated vaginally. Ethanol, 5 ml was injected in the cyst. By three months there was reformation of endometrioma and a repeat second aspiration was done. Danazol 400 mgs/day, in divided doses was given for three months. Two years after TAH+BSO, third time aspiration of 7 ml thick chocolate liquid was done from 2 cms cyst and 4 ml spirit, absolute alcohol was injected on 15.1.98. We present our first case of ethanol sclerotherapy to treat recurrent endometriotic cyst after hysterectomy and bilateral salpingo oophorectomy in 1996-1998. In two other cases ERT had resulted in early recurrence of endometriosis, hence should be avoided. Endometriosis being a recurrent disease, the management decisions had to be individualized. We have discussed about Ethanol sclero therapy, reasons for recurrence after TAH+BSO, and the side effects of Danazol. 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The efficiency of sclerotherapy for the management of endometrioma: a systematic review and meta-analysis of clinical and fertility outcomes. Medicina (Kaunas). 2023;59(9):1643. Castellarnau Visus M, Ponce Sebastia J, Carreras Collado R, Cayuela Font E, Garcia Tejedor A. Preliminary results: ethanol sclerotherapy after ultrasound-guided fine needle aspiration without anesthesia in the management of simple ovarian cysts. J Minim Invasive Gynecol. 2015;22(3):475-82. Younis JS, Shapso N, Izhaki I, Taylor HS. Ethanol sclerotherapy for management of endometriomas: an overview of systematic reviews. Front Endocrinol (Lausanne). 2025;16:1612899. Sükür YE, Aslan B, Varlı B, Özcan P, Daniilidis A, Kalaitzopoulos DR. Ethanol sclerotherapy for endometriomas in infertile women: a narrative review. J Clin Med. 2024;13(24):7548. Lentzaris D, Gkrozou F, Skentou C, Angelidis P, Theodosiadis N, Kalampokas T. Future of sclerotherapy in the treatment of endometriosis: a narrative literature review. 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Brunes M, Johannesson U, Häbel H, Forsgren C, Moawad G, Ek M. Peri- and postoperative outcomes in patients with endometriosis undergoing hysterectomy. Eur J Obstet Gynecol Reprod Biol. 2022;272:104-9. Fuldeore MJ, Chwalisz K, Marx S, Wu N, Boulanger L, Ma L, et al. Surgical procedures and their cost estimates among women with newly diagnosed endometriosis: a US database study. J Med Econ. 2011;14(1):115-23. Hamoda H, Moger S, Morris E, Baldeweg SE, Kasliwal A, Gabbay F. Menopause practice standards. Clin Endocrinol (Oxf). 2022;97(6):809-14. Soliman NF, Hillard TC. Hormone replacement therapy in women with past history of endometriosis. Climacteric. 2006;9(4):325-35. Kitawaki J, Kado N, Ishihara H, Koshiba H, Kitaoka Y, Honjo H. Endometriosis: the pathophysiology as an estrogen-dependent disease. J Steroid Biochem Mol Biol. 2002;83(5):149-55. Bulun SE, Monsavais D, Pavone ME, Dyson M, Xue Q, Attar E, et al. Role of estrogen receptor-beta in endometriosis. Semin Reprod Med. 2012;30(1):39-45. Hamoda H. British Menopause Society Medical Advisory Council. British Menopause Society tools for clinicians: progestogens and endometrial protection. Post Reprod Health. 2022;28(1):40-6. Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, et al. ESHRE guideline: endometriosis. Hum Reprod Open. 2022;2022(2):hoac009. Fournier A, Berrino F, Clavel-Chapelon F. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Res Treat. 2008;107(1):103-11. Asi N, Mohammed K, Haydour Q, Gionfriddo MR, Vargas OL, Prokop LJ, et al. Progesterone vs synthetic progestins and the risk of breast cancer: a systematic review and meta-analysis. Syst Rev. 2016;5:121.

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