The Outcome of Ethanol Directed Sclerotherapy for the Management of Endometrioma: A Systematic Review

I Gusti Ngurah Agung Trisnu Kamajaya, Anom Suardika, Putu Doster Mahayasa, Nyoman Gede Budiana, Gede Bagus Kantwa Abhimantra
In: Indonesian Journal of Perinatology · 2024 · vol. 5(2) , pp. 62–66 · doi:10.51559/inajperinatol.v5i2.56 · W4406230192
Systematic review / meta-analysis OA: diamond CC0
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This systematic review of nine studies found ethanol-directed sclerotherapy for endometrioma achieves high success rates and low recurrence, though its impact on ovarian reserve and fertility remains inconclusive due to protocol variability.

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This systematic review analyzed nine studies involving 499 patients to evaluate the efficacy of ethanol-directed sclerotherapy as a minimally invasive treatment for ovarian endometriomas. The authors found that the procedure demonstrated a success rate exceeding 80% and a recurrence rate below 30%, offering a potential alternative to laparoscopic cystectomy with lower risks to ovarian reserve. However, the review noted significant variability in procedural protocols and inconclusive data regarding long-term fertility outcomes and pregnancy rates across the included studies. This paper is centrally about endometriosis — specifically the management of ovarian endometriomas using ethanol-directed sclerotherapy.

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Abstract

Background and Objectives: Ovarian endometriomas, commonly known as chocolate cysts, are prevalent gynecological conditions associated with chronic pelvic pain and infertility. Current standard treatment, laparoscopic cystectomy, poses risks such as reduced ovarian reserve. Ethanol-directed sclerotherapy has emerged as a minimally invasive alternative aiming to preserve ovarian tissue while treating endometriomas. This systematic review evaluates the outcome of ethanol directed sclerotherapy for the management of endometrioma. Methods: Following PRISMA guidelines, databases including PubMed, EMBASE, and Cochrane were searched in January 2024 using “endometrioma and sclerotherapy.” Inclusion criteria encompassed studies reporting success rate (SR), RR, and pregnancy rate (PR) post-treatment. Nine studies involving 499 patients were analyzed. Results: Ethanol sclerotherapy demonstrated >80% SR in six studies and <30% RR in seven studies, indicating efficacy in reducing recurrence. However, its impact on ovarian reserve remains inconclusive. Pregnancy outcomes were inconsistently reported, with one study achieving 100% PR, while others ranged from 0% to >30%. Variability in techniques, such as ethanol concentration and retention time, likely influenced outcomes. Conclusions: Ethanol sclerotherapy offers a promising alternative to surgery, showing lower RR and potential preservation of ovarian function. Despite these benefits, inconsistencies in procedural protocols and limited data on long-term fertility outcomes necessitate further research. Standardized guidelines and larger cohort studies are essential to establish sclerotherapy's role in endometrioma management, especially for fertility preservation.
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Keywords

Ovarian Endometrioma, Ethanol Directed Sclerotherapy, Recurrence Rate and Succession Rate

Abstract

Background and Objectives: Ovarian endometriomas, commonly known as chocolate cysts, are prevalent gynecological conditions associated with chronic pelvic pain and infertility. Current standard treatment, laparoscopic cystectomy, poses risks such as reduced ovarian reserve. Ethanol-directed sclerotherapy has emerged as a minimally invasive alternative aiming to preserve ovarian tissue while treating endometriomas. This systematic review evaluates the outcome of ethanol directed sclerotherapy for the management of endometrioma.

Methods

Following PRISMA guidelines, databases including PubMed, EMBASE, and Cochrane were searched in January 2024 using “endometrioma and sclerotherapy.” Inclusion criteria encompassed studies reporting success rate (SR), RR, and pregnancy rate (PR) post-treatment. Nine studies involving 499 patients were analyzed.

Results

Ethanol sclerotherapy demonstrated >80% SR in six studies and <30% RR in seven studies, indicating efficacy in reducing recurrence. However, its impact on ovarian reserve remains inconclusive. Pregnancy outcomes were inconsistently reported, with one study achieving 100% PR, while others ranged from 0% to >30%. Variability in techniques, such as ethanol concentration and retention time, likely influenced outcomes.

Conclusions

Ethanol sclerotherapy offers a promising alternative to surgery, showing lower RR and potential preservation of ovarian function. Despite these benefits, inconsistencies in procedural protocols and limited data on long-term fertility outcomes necessitate further research. Standardized guidelines and larger cohort studies are essential to establish sclerotherapy's role in endometrioma management, especially for fertility preservation.

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endometriomachronic_pelvic_paininfertility

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