Ethanol sclerotherapy and laparoscopic cystectomy for ovarian endometriomas. Comparative analysis of efficacy and reproductive outcomes

Objective. To study and systematize the results of ethanol sclerotherapy in patients with ovarian endometriomas and perform a comparative analysis of the efficacy of sclerotherapy and cystectomy according to international research publications. Materials and methods. Electronic searching was conducted through Medline, PubMed, Google Scholar, ClinicalTrials, and Cochrane Library databases for cohort studies and randomized controlled trials only. A systematic review was performed using preferred reporting items for systematic reviews and meta-analyses (PRISMA). A total of 626 articles were reviewed. The Cochrane Collaboration’s tool was used to assess the quality of the studies. Results. It was shown that ethanol sclerotherapy for ovarian endometriomas bears the lowest risk in terms of surgical complications; it is highly economical in combination with maximum fertility preservation, which is especially relevant in assisted reproductive technology programs. The effectiveness of this method is largely determined by the conditions for its use, as well as by the time of ethanol exposure (optimally not less than 7 minutes). At the same time, ethanol puncture of endometrial cysts is not a monotherapy, and its outcome is greatly influenced by the adequacy of postoperative hormonal treatment. The use of 30 μg ethinylestradiol + 2 mg dienogest was shown to be promising. Conclusion. Ethanol sclerotherapy for ovarian endometriomas should be performed in accordance with the developed conditions and indications for its use in combination with postoperative hormonal treatment. Key words: endometriosis, ovarian endometrioma, sclerotherapy, cystectomy, ethinylestradiol + dienogest