Comparison of the Efficacy and Safety of Ultrasound-Guided Sclerotherapyversus Cystectomy for the Treatment of Ovarian Endometriomas: A SystematicReview and Meta-Analysis

You Jian He, Dan Wang, Youlin Deng
In: Current Women s Health Reviews · 2023 · vol. 20(2) · doi:10.2174/1573404820666230328121709 · W4362637820
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-07 ⓘ

This meta-analysis of six studies found ultrasound-guided sclerotherapy is not inferior to cystectomy for ovarian endometriomas regarding recurrence or pregnancy rates, with significantly fewer severe complications.

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This systematic review and meta-analysis compared ultrasound-guided sclerotherapy versus ovarian cystectomy for ovarian endometriomas, drawing on six studies totaling 386 patients across PubMed-MEDLINE, EMBASE, Cochrane, and Scopus. It directly compared recurrence, pain relief, pregnancy, technical success, and complication rates, finding that sclerotherapy had higher recurrence risk than cystectomy without statistical significance overall (OR 1.57, p = 0.52), with a notable recurrence increase for indwelling time ≤ 10 minutes (OR 22.01, p = 0.001). Pregnancy rates were compared as well, with cystectomy showing a lower rate after analysis but no significant difference (OR 1.67, p = 0.22), and severe complications (Clavien–Dindo III–V) occurring more with cystectomy than with sclerosis (16.67% vs 0%). The main limitation explicitly implied by the paper’s results is the small number of included studies/patients (six studies, 386 patients), which affects precision of subgroup findings. This paper is centrally about endometriosis—specifically ultrasound-guided sclerotherapy versus cystectomy outcomes for ovarian endometriomas.

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Abstract

Background: Ultrasound-guided sclerosis has been used to treat ovarian endometriotic cysts since 1988. However, compared with cystectomy, sclerotherapy's effectiveness and safety are questionable. Objective: To compare ultrasound-guided sclerotherapy and ovarian cystectomy in the treatment of ovarian endometriosis through a systematic review and meta-analysis. Methods: PubMed-MEDLINE, EMBASE, Cochrane, and Scopus databases were searched, and related literature was collected. The two treatments' recurrence rate, pain relief rate, pregnancy rate, technical success rate, and complication rate were directly compared. Results: Six studies (386 patients) were included. The risk of recurrence with sclerotherapy was higher than that with cystectomy (OR 1.57, p = 0.52). Subgroup analysis showed that an indwelling time > 10 min was not significantly different regarding recurrence risk between sclerotherapy and cystectomy (OR 1.01, p = 0.99). When the indwelling time was ≤ 10 min, the risk of recurrence with sclerotherapy was significantly higher than that with cystectomy (OR 22.01, p = 0.001). The pregnancy rate after cystectomy was lower than that after sclerosis (OR 1.67, p = 0.22). Complications in the study were graded according to the Clavien‒Dindo classification and statistical analysis showed that the probability of serious complications (Grade III-V) with cystectomy was higher than that with sclerosis (16.67% vs. 0%). Conclusion: Ultrasound-guided sclerotherapy was not inferior to cystectomy in terms of recurrence rate or pregnancy rate, and the incidence of severe complications was lower than that in the cystectomy group. Sclerotherapy is a safe and effective alternative treatment for ovarian endometriosis.
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Abstract

Background: Ultrasound-guided sclerosis has been used to treat ovarian endometriotic cysts since 1988. However, compared with cystectomy, sclerotherapy's effectiveness and safety are questionable.

Objective

To compare ultrasound-guided sclerotherapy and ovarian cystectomy in the treatment of ovarian endometriosis through a systematic review and meta-analysis.

Methods

PubMed-MEDLINE, EMBASE, Cochrane, and Scopus databases were searched, and related literature was collected. The two treatments' recurrence rate, pain relief rate, pregnancy rate, technical success rate, and complication rate were directly compared.

Results

Six studies (386 patients) were included. The risk of recurrence with sclerotherapy was higher than that with cystectomy (OR 1.57, p = 0.52). Subgroup analysis showed that an indwelling time > 10 min was not significantly different regarding recurrence risk between sclerotherapy and cystectomy (OR 1.01, p = 0.99). When the indwelling time was ≤ 10 min, the risk of recurrence with sclerotherapy was significantly higher than that with cystectomy (OR 22.01, p = 0.001). The pregnancy rate after cystectomy was lower than that after sclerosis (OR 1.67, p = 0.22). Complications in the study were graded according to the Clavien‒Dindo classification and statistical analysis showed that the probability of serious complications (Grade III-V) with cystectomy was higher than that with sclerosis (16.67% vs. 0%).

Conclusion

Ultrasound-guided sclerotherapy was not inferior to cystectomy in terms of recurrence rate or pregnancy rate, and the incidence of severe complications was lower than that in the cystectomy group. Sclerotherapy is a safe and effective alternative treatment for ovarian endometriosis.

Keywords

Endometriosis, ovary, sclerotherapy, cystectomy, recurrence, pregnancy. [http://dx.doi.org/10.1038/s41572-018-0008-5] [PMID: 30026507] [http://dx.doi.org/10.1016/S0140-6736(04)17403-5] [PMID: 15541453] [http://dx.doi.org/10.3109/00016348709022053] [PMID: 3425247] [http://dx.doi.org/10.1007/s10815-010-9436-1] [PMID: 20574791] [http://dx.doi.org/10.1016/j.bpobgyn.2018.12.013] [http://dx.doi.org/10.1016/S0015-0282(99)00211-3] [PMID: 10439002] [http://dx.doi.org/10.1046/j.1445-2197.2003.02748.x] [PMID: 12956787] [http://dx.doi.org/10.1016/j.jmig.2019.08.036] [PMID: 32272240] [http://dx.doi.org/10.1002/rmb2.12386] [PMID: 34262399] [http://dx.doi.org/10.1016/j.ejogrb.2021.01.027] [http://dx.doi.org/10.1007/s00330-020-07111-1] [PMID: 32770376] [http://dx.doi.org/10.1016/S0020-7292(00)00307-6] [PMID: 11146075] [http://dx.doi.org/10.3348/kjr.2015.16.6.1188] [PMID: 26576107] [http://dx.doi.org/10.3348/kjr.2015.16.6.1175] [PMID: 26576106] [http://dx.doi.org/10.1136/bmj.327.7414.557] [PMID: 12958120] [http://dx.doi.org/10.1136/bmj.323.7304.101] [http://dx.doi.org/10.1007/s00330-021-08270-5] [PMID: 34580747] [http://dx.doi.org/10.1210/jc.2012-1558] [PMID: 22723324] [http://dx.doi.org/10.1016/j.rbmo.2011.07.014] [PMID: 22019621] [http://dx.doi.org/10.1016/S0015-0282(98)00219-2] [PMID: 9757884] [http://dx.doi.org/10.1016/j.ajog.2005.05.056] [PMID: 16325591] [http://dx.doi.org/10.1016/j.fertnstert.2014.12.101] [PMID: 25577464] [http://dx.doi.org/10.5114/pm.2022.114404] [PMID: 35388278] [http://dx.doi.org/10.1016/j.fertnstert.2017.05.015] [PMID: 28579409] [http://dx.doi.org/10.1016/S0301-2115(02)00144-6] [PMID: 12270563] [http://dx.doi.org/10.1056/NEJMra1810764] [PMID: 32212520]

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endometriosis

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