Efficacy of the revised Enzian classification: a retrospective analysis. Does the revised Enzian classification solve the problem of duplicate classification in rASRM and Enzian?

Dietmar Haas, Peter Wurm, Andreas Shamiyeh, Omar Shebl, Radek Chvátal, Radek Chvatal, Peter Oppelt
Archives of gynecology and obstetrics · 2012 · vol. 287(5) , pp. 941–945 · doi:10.1007/s00404-012-2647-1 · PMID:23212664 · W2093972363
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-11 ⓘ

This study analyzed if the revised Enzian classification avoids duplicate classification with rASRM and found no duplicate classifications when using Enzian alone for DIE lesions.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text ⓘ

This retrospective study evaluated 460 women admitted for endometriosis, using both the Revised American Society for Reproductive Medicine (rASRM) and the revised Enzian classification to assess whether the revised Enzian system is easier to apply and avoids duplicate lesion classification given partial overlap between systems. Deeply infiltrating endometriosis (DIE) was histologically confirmed in 187/460 (41%) patients using the revised Enzian classification, and further Enzian compartment scoring identified 270 retroperitoneal lesions, reflecting that some patients had multiple lesion types across compartments. The study reports that all 270 lesions were classified using Enzian alone and that there were no duplicate classifications between rASRM and Enzian, with the key limitation being that the paper is retrospective and provides the asserted benefit without additional prospective usability comparisons. This paper is centrally about endometriosis — it tests whether the revised Enzian classification improves staging of deeply infiltrating endometriosis and resolves duplicate classification with rASRM.

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Abstract

Purpose The most widely accepted classification for endometriosis is the Revised American Society for Reproductive Medicine (rASRM) system, but this does not take deeply infiltrating endometriosis (DIE) into account. The Enzian classification enables clinicians to classify DIE. Due to complexity and partial overlap with rASRM, it was revised for a second time in February 2011. Using both the systems to classify lesions would be inappropriate, as they refer to different locations. The aim of this study was to analyze whether the revised Enzian classification is easier to use and avoids duplicate classifications.

Methods

Retrospective study of 460 women admitted for endometriosis.

Results

One hundred and eighty-seven of 460 patients (41 %) had histologically confirmed DIE based on the revised Enzian classification. Further classification of these 187 patients using Enzian revealed 270 retroperitoneal lesions, as some patients had several DIE-type lesions simultaneously: 66 in compartment A (rectovaginal septum, vagina), 112 in compartment B (sacrouterine ligaments, pelvic wall), 58 in compartment C (bowel), 15 with adenomyosis uteri, 7 with bladder involvement, 8 with intrinsic involvement of the ureter, and 4 with bowel involvement. All 270 lesions were classified using Enzian alone and not with the rASRM score. There were no duplicate classifications (rASRM and Enzian).

Conclusions

The revised Enzian classification is an excellent complement to the rASRM score for morphological description of DIE. Similar content being viewed by others Abbreviations - AFS: - American Fertility Society - DIE: - Deeply infiltrating endometriosis - EFI: - Endometriosis fertility index - IRB: - Institutional review board - rAFS: - Revised American Fertility Society (score) - rASRM: - Revised American Society for Reproductive Medicine (score)

References

Schweppe KW (2003) Endometriosis—a disease that has no lobby. Zentralbl Gynakol 125:233 (German) Burghaus S et al (2011) Risk factors for endometriosis in a German case-control study. Geburtsh Frauenheilk 71(12):1073–1079 Zimmermann A, Brandes I, Babitsch B (2010) Information needs of women with endometriosis within the scope of healthcare provision. Geburtsh Frauenheilk 70(7):568–573 Lockyer C (1918) A new classification of adenomyoma. In: Lockyer C (ed) Fibroids and allied tumours (myoma and adenomyoma): their pathology, clinical features and surgical treatment. Macmillan, London, pp 306–378 Acosta AA, Buttram VC Jr, Besch PK, Malinak LR, Franklin RR, Vanderheyden JD (1973) A proposed classification of pelvic endometriosis. Obstet Gynecol 42:19–25 Albrecht H (1955) Die Endometriose. In: Seitz L, Amreich AI (eds) Biologie und Pathologie des Weibes: Ein Handbuch der Frauenheilkunde und der Geburtshilfe, vol 4, 2nd edn. Urban and Schwarzenberg, Berlin, pp 190–288 The American Fertility Society (1979) Classification of endometriosis. Fertil Steril 32:633–634 The American Fertility Society (1985) Revised American Fertility Society classification of endometriosis: Fertil Steril 43:351–352 American Society for Reproductive Medicine (1996) Revised American Society for Reproductive Medicine classification of endometriosis: Fertil Steril 67:817–821 Kubiak A, Dieterle S, Neuer A, Bierhals K, Greb R. Stadiengerechte Fertilitätseinschränkungen bei peritonealer und tief-infiltrierender Endometriose: Welche Mechanismen werden durch die in vitro Fertilisation erkennbar. Geburtsh Frauenheilk 2011 71 Adamson GD, Pasta DJ (2010) Endometriosis fertility index: the new, validated endometriosis staging system. Fertil Steril 94:1609–1615 Tuttlies F, Keckstein J, Ulrich U, Possover M, Schweppe KW, Wustlich M et al (2005) ENZIAN-score, a classification of deep infiltrating endometriosis. Zentralbl Gynakol 127:275–281 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 95:1574–1578 Stiftung Endometriose Forschung (2010) 6th Conference of the Stiftung Endometriose Forschung (Foundation for Endometriosis Research). Hotel Enzian, Weissensee, Austria, February 19–21, 2010 Stiftung Endometriose Forschung (2011) The revised Enzian classification. [Consensus meeting, 7th Conference of the Stiftung Endometriose Forschung (Foundation for Endometriosis Research), Hotel Enzian, Weissensee, Austria, February 25–27, 2011.] Weissensee, Austria: Stiftung Endometriose Forschung (SEF) Mechsner S, Infanger M, Ebert AD, Schneider A, Bartley J (2010) Abdominal wall endometriosis—diagnosis and therapeutic management. Geburtsh Frauenheilk 70(3):207–214 Gardanis K et al (2010) Minimally invasive surgery for deep infiltrating endometriosis in the rectovaginal septum. Geburtsh Frauenheilk 70(3):194–200 Koninckx PR, Martin DC (1992) Deep endometriosis: a consequence of infiltration or retraction or possibly adenomyosis externa? Fertil Steril 58(5):924–928 Acknowledgments The authors would like to thank the Medical Society of Upper Austria (Medizinische Gesellschaft für Oberösterreich) for providing support for this study. Conflict of interest The authors have stated explicitly that there are no conflicts of interest in connection with this article. None of the authors has received any financial support for this study, and the contents have not been presented previously at any meeting. Institutional review board (IRB) approval was obtained. Author information Authors and Affiliations Corresponding author Additional information Registration number of the ethical review committee, Linz, Austria, 2010: C-11-10 (2.1.7). Rights and permissions About this article Cite this article Haas, D., Wurm, P., Shamiyeh, A. et al. Efficacy of the revised Enzian classification: a retrospective analysis. Does the revised Enzian classification solve the problem of duplicate classification in rASRM and Enzian?. Arch Gynecol Obstet 287, 941–945 (2013). https://doi.org/10.1007/s00404-012-2647-1 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00404-012-2647-1

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Colon Colon Endometriosis Endometriosis Endometriosis Female Humans Pelvis Pelvis Rectum Rectum Retrospective Studies Ureter Ureter Urinary Bladder Urinary Bladder Vagina Vagina

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