Nonsurgical radiologic intervention for management of abdominal wall endometriosis: A systematic review and meta-analysis

Objective:To describe reported outcomes of nonsurgical radiologic interventions for abdominal wall endometriosis in comparison with surgery where available.Data sources:A systematic search of Ovid Medline, Embase, PubMed, and Cochrane Controlled Register of Trials was performed from inception to January 2019 with no language restrictions.Study eligibility criteria:Studies were included if they evaluated a nonsurgical intervention in women with symptomatic abdominal wall endometriosis with both comparative and noncomparative study designs.Study appraisal and synthesis methods:Titles and abstracts were reviewed for relevance, and full-text articles were obtained and evaluated for inclusion, all in duplicate. Meta-analysis was performed when possible using a fixed effects model.Results:Of the 114 records reviewed, 16 full-text articles were assessed and 7 were included in analysis. The standard mean difference between pre- and post-intervention pain scores was similar between ultrasound-guided high-intensity focused ultrasound (USgHIFU) (−3.00; 95% confidence interval −3.34, −2.66) and cryoablation (−3.93; 95% confidence interval −5.73, −2.12). The mean percent decrease in lesion size following intervention was similar between USgHIFU (−61.38%; 95% confidence interval −78.64%, −44.11%), and cryoablation (−88.16%; 95% confidence interval −83.90%, −55.06%). When compared with surgical excision, mean length of stay was 2.78 days less in the nonsurgical intervention group (95% confidence interval −3.78, −1.79).Conclusions:Both USgHIFU and cryoablation are effective at reducing pain scores and lesion size in abdominal wall endometriosis. Mean length of stay was significantly less following a nonsurgical radiologic intervention for abdominal wall endometriosis compared with surgery. More studies are needed comparing complication and recurrence rates between nonsurgical radiologic interventions for abdominal wall endometriosis and surgery.