A prospective study to evaluate the effectiveness of ultrasound‐guided transvaginal aspiration in the treatment of recurrent endometrioma

Purpose: Recurrent endometrioma is a difficult clinical problem. Repeated conservative surgical treatment carries increase risk of damage to adjacent organs. Medical treatment has not been found effective. Ultrasound‐guided aspiration is an attractive option because it can be performed under conscious sedation and is applicable even when surgical excision is technically difficult. We postulated that the endometriotic tissue in the epithelial lining had undergone pressure atrophy after a period of observation and resolution of the endometrioma can be achieved by aspiration of its content. Methods: A prospective study was carried out in which patients with recurrent endometrioma that remain stationary in size for a period of at least 6‐month duration were included. Ultrasound‐guided aspiration of endometrioma was performed transvaginally under conscious sedation. Ultrasound scan examination was performed at 1, 3, 6 and 12 months after aspiration to detect recurrence. Results: Eight endometriomas were aspirated in six patients. All aspiration procedures were successful. The mean diameter and volume of endometrioma at aspiration were 31.0 mm (18.0–46.3) and 21.9 mL (3.16–52), respectively. The mean duration of procedure was 34.5 min (15–50). There were no major complications. Cytological examination revealed hemosiderin‐laden macrophages; neither malignant cells nor endometrial cells were detected in all cases. Six ovarian cysts recurred in five women (83.3%), all recurrence were detected within 3 months after aspiration. Conclusions: We concluded that although transvaginal ultrasound‐guided aspiration is a safe procedure. However, the recurrence rate after aspiration is unacceptably high, and hence cannot be recommended as a treatment option for recurrent endometrioma.