Endosalpingosis ("endosalpingoblastosis") following laparoscopic tubal coagulation as an etiologic factor of ectopic pregnancy

Recent literature has suggested that the majority of pregnancies following a laparoscopic tubal coagulation failure are ectopic. This is in direct contrast to the failure of other types of tubal ligation procedures which usually result in intrauterine pregnancies. The purpose of this paper is to explain this disparity in hopes of reducing the chance of ectopic pregnancies. A study of pathology is presented and how different portions of the oviduct respond to coagulation injury is reported. It was found that the endosalpinx of the proximal oviduct, which is so frequently injured during laparoscopic coagulation, becomes activated (endosalpingosis or "endosalpingoblastosis") with potential fistula formation. If the coagulation is more distal only fibrosis occurs. This is clinically significant in that if the laparoscopist avoids injury to the proximal isthmic portion of the oviduct, the chance of "endosalpingoblastosis," fistula, and ectopic pregnancy should be reduced, thus improving the outcome of this technique.