The #Enzian classification for the diagnosis and surgery of endometriosis: a narrative review

This narrative review evaluates existing endometriosis classification systems and argues that the widely used rASRM scheme is limited because it is based largely on intraoperative findings and does not adequately represent deep endometriosis (DE) or subtle lesions, leading to poor prediction of pelvic pain, infertility, and surgical difficulty or outcome, with imaging correlations also noted as inconsistent. It describes how the Enzian classification (created in 2003) provides a detailed description of DE lesion location and severity, can be used alongside rASRM for superficial/ovarian disease, and has evidence for correlating with symptoms, duration/difficulty of surgery, and some postoperative complications, while also discussing how digital scoring (e.g., EQUSUM) improves classification reliability. A related fertility-focused metric (EFI) is reviewed as a probability-of-conception tool that incorporates rASRM but is not itself a DE-focused endometriosis classification. The paper does not explicitly discuss adenomyosis; it is centrally about endometriosis classification, and thus relates to endometriosis by assessing how DE is incorporated in the Enzian/#Enzian system for diagnosis and surgical planning.

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