Die #Enzian-Klassifikation für die nicht invasive und invasive Diagnostik der Endometriose

J. Keckstein, Jörg Keckstein, Markus Hoopmann, Gernot Hudelist
In: Frauenheilkunde up2date · 2023 · vol. 17(03) , pp. 237–251 · doi:10.1055/a-1719-9474 · W4381620862
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The #Enzian classification provides a comprehensive and standardized method for assessing and classifying endometriosis in both non-invasive diagnostics and surgical settings.

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This paper proposes the #Enzian classification system as a standardized, comprehensive way to describe and classify endometriosis for both non-invasive diagnostic settings (e.g., ultrasound and MRI) and surgical assessment, addressing limitations of older classifications that inadequately represent disease extent. It describes a coding approach that accounts for all affected anatomic structures, including complex manifestations such as TIE, and explicitly avoids reducing findings to a single overall stage as done in systems like rASRM. The authors note that prior application studies reported good applicability, high reproducibility of findings, and correlations with important disease and treatment factors, while the major caveat is the absence of an overall staging reduction, which is a deliberate design choice rather than a simplification. This paper is centrally about endometriosis — it presents the #Enzian classification for non-invasive and invasive diagnostics of endometriosis, which directly supports structured mapping of disease extent.

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Abstract

Die Endometriose ist eine komplexe Erkrankung mit sehr unterschiedlichen Erscheinungsformen und Symptomen. Die bisher verwendeten Klassifikationen geben das Ausmaß der Erkrankung nur unzureichend wieder. Die #Enzian-Klassifikation ist eine neue Klassifikation, die eine vollständige und standardisierte Beurteilung und Klassifizierung der Endometriose ermöglicht – sowohl für die nicht invasive Diagnostik als auch in der Chirurgie.
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Subscribe to RSS DOI: 10.1055/a-1719-9474 Die #Enzian-Klassifikation für die nicht invasive und invasive Diagnostik der Endometriose Authors Die Endometriose ist eine komplexe Erkrankung mit sehr unterschiedlichen Erscheinungsformen und Symptomen. Die bisher verwendeten Klassifikationen geben das Ausmaß der Erkrankung nur unzureichend wieder. Die #Enzian-Klassifikation ist eine neue Klassifikation, die eine vollständige und standardisierte Beurteilung und Klassifizierung der Endometriose ermöglicht – sowohl für die nicht invasive Diagnostik als auch in der Chirurgie. - Die Endometriose ist eine komplexe Erkrankung mit sehr unterschiedlichen Erscheinungsformen und Symptomen. - Sie betrifft nicht nur das innere Genitale, sondern auch alle benachbarten Organe im Becken sowie extraperitoneal und extraabdominal gelegene Organe. - Die bisher verwendeten Klassifikationen geben das Ausmaß der Erkrankung nur unzureichend wieder. - Die #Enzian-Klassifikation ist ein umfassendes System, um die Endometriose vollständig zu klassifizieren und für verschiedene diagnostische Verfahren nutzbar zu machen. - Die Kodierung berücksichtigt alle betroffenen anatomischen Strukturen, einschließlich der sehr komplexen Manifestation der TIE und auch weniger häufig betroffener Lokalisationen. - Die Möglichkeit, die Klassifikation auch im Rahmen der nicht invasiven Diagnostik (Ultraschall und MRT) und in Kombination mit der Chirurgie einzusetzen, verbessert die interdisziplinäre Kommunikation. - Die #Enzian-Klassifikation liefert bewusst keine vereinfachte Reduktion der erhobenen Befunde auf ein Gesamtstadium (z. B. Stadium 1–4) wie bei der rASRM-Klassifikation. Damit bildet sie das Ausmaß der Erkrankung vollständig ab, um auch in Zukunft mehr Informationen über die Komplexität der Erkrankung zu erhalten. - Die bisher durchgeführten Studien zur Anwendung der #Enzian-Klassifikation zeigen eine gute Anwendbarkeit und hohe Genauigkeit hinsichtlich der Reproduzierbarkeit der Befunde und der Korrelation mit wichtigen Faktoren der Erkrankung und ihrer Behandlung. Publication History Article published online: 22 June 2023 © 2023. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany - Literatur - 1 Guerriero S, Condous G, van den Bosch T. et al. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol 2016; 48: 318-332 - 2 Keckstein J, Hoopmann M, Merz E. et al. Expert opinion on the use of transvaginal sonography for presurgical staging and classification of endometriosis. Arch Gynecol Obstet 2023; 307: 5-19 - 3 Djokovic D, Pinto P, van Herendael BJ. et al. Structured report for dynamic ultrasonography in patients with suspected or known endometriosis: Recommendations of the International Society for Gynecologic Endoscopy (ISGE). Eur J Obstet Gynecol Reprod Biol 2021; 263: 252-260 - 4 The American Fertility Society. Classification of endometriosis. Fertil Steril 1979; 32: 633-634 - 5 Hudelist G, Valentin L, Saridogan E. et al. What to choose and why to use – a critical review on the clinical relevance of rASRM, EFI and Enzian classifications of endometriosis. Facts Views Vis Obgyn 2021; 13: 331-338 - 6 Montanari E, Bokor A, Szabó G. et al. Comparison of# Enzian classification and revised American Society for Reproductive Medicine stages for the description of disease extent in women with deep endometriosis. Hum Reprod 2022; 37: 2359-2365 - 7 Metzemaekers J, Haazebroek P, Smeets M. et al. EQUSUM: Endometriosis QUality and grading instrument for SUrgical performance: proof of concept study for automatic digital registration and classification scoring for r-ASRM, EFI and Enzian. Hum Reprod Open 2020; 2020: hoaa053 - 8 Adamson GD, Pasta DJ. Endometriosis fertility index: the new, validated endometriosis staging system. Fertil Steril 2010; 94: 1609-1615 - 9 Tomassetti C, Bafort C, Vanhie A. et al. Estimation of the Endometriosis Fertility Index prior to operative laparoscopy. Hum Reprod 2021; 36: 636-646 - 10 Keckstein J, Ulrich U, Possover M, Schweppe KW. ENZIAN-Klassifikation der tief infiltrierenden Endometriose. Zentralbl Gynäkol 2003; 125: 291 - 11 Montanari E, Dauser B, Keckstein J. et al. Association between disease extent and pain symptoms in patients with deep infiltrating endometriosis (DIE). Hum Reprod 2019; 34: 62-63 - 12 Keckstein J, Hudelist G. Classification of deep endometriosis (DE) including bowel endometriosis: From r-ASRM to# Enzian-classification. Best Pract Res Clin Obstet Gynaecol 2021; 71: 27-37 - 13 Johnson NP, Hummelshoj L, Adamson GD. et al. World Endometriosis Society consensus on the classification of endometriosis. Hum Reprod 2017; 32: 315-324 - 14 Vanhie A, Meuleman C, Tomassetti C. et al. Consensus on Recording Deep Endometriosis Surgery: the CORDES statement. Hum Reprod 2016; 31: 1219-1223 - 15 Keckstein J, Becker CM, Canis M. et al. Recommendations for the surgical treatment of endometriosis. Part 2: deep endometriosis. Hum Reprod Open 2020; 2020: hoaa002 - 16 Keckstein J, Saridogan E, Ulrich UA. et al. The# Enzian classification: A comprehensive non-invasive and surgical description system for endometriosis. Acta Obstet Gynecol Scand 2021; 100: 1165-1175 - 17 Hudelist G, Montanari E, Salama M. et al. Comparison between sonography-based and surgical extent of deep endometriosis using the Enzian classification - a prospective diagnostic accuracy study. J Minim Invasive Gynecol 2021; 28: 1643-1649.e1 - 18 Di Giovanni A, Montanari E, Hudelist G. et al. Comparison between sonography-based and surgical evaluation of endometriotic lesions using the #Enzian classification – a retrospective data analysis. Eur J Ultrasound 2022; - 19 Montanari E, Bokor A, Szabó G. et al. Accuracy of sonography for non-invasive detection of ovarian and deep endometriosis using# Enzian classification: prospective multicenter diagnostic accuracy study. Ultrasound Obstet Gynecol 2022; 59: 385-391 - 20 Bindra V, Nori M, Mohanty GS. et al. Pre-operative mapping and structured reporting of pelvic endometriotic lesions on dynamic ultrasound and its correlation on laparoscopy using the# Enzian Classification. Arch Gynecol Obstet 2023; 307: 179-186 - 21 Fendal Tunca A, Iliman DE, Akdogan Gemici A, Kaya C. Predictive value of preoperative MRI using the# ENZIAN classification score in patients with deep infiltrating endometriosis. Arch Gynecol Obstet 2023; 307: 215-220 - 22 Di Paola V, Manfredi R, Castelli F. et al. Detection and localization of deep endometriosis by means of MRI and correlation with the ENZIAN score. Eur J Radiol 2015; 84: 568-574 - 23 Thomassin-Naggara I, Lamrabet S, Crestani A. et al. Magnetic resonance imaging classification of deep pelvic endometriosis: description and impact on surgical management. Hum Reprod 2020; 35: 1589-1600 - 24 Manganaro L, Celli V, Dolciami M. et al. Can new ENZIAN Score 2020 represent a staging system improving MRI structured report?. Int J Environ Res Pub Health 2021; 18: 9949 - 25 Burla L, Scheiner D, Samartzis EP. et al. The ENZIAN score as a preoperative MRI-based classification instrument for deep infiltrating endometriosis. Arch Gynecol Obstet 2019; 300: 109-116 - 26 Haas D, Oppelt P, Shebl O. et al. Enzian classification: does it correlate with clinical symptoms and the rASRM score?. Acta Obstet Gynecol Scand 2013; 92: 562-566 - 27 Roman H, Moatassim-Drissa S, Marty N. et al. Rectal shaving for deep endometriosis infiltrating the rectum: a 5-year continuous retrospective series. Fertil Steril 2016; 106: 1438-1445.e2 - 28 Poupon C, Owen C, Arfi A. et al. Nomogram predicting the likelihood of complications after surgery for deep endometriosis without bowel involvement. Eur J Obstet Gynecol Reprod Biol 2019; 3: 100028 - 29 Imboden S, Bollinger Y, Harma K. et al. Predictive factors for voiding dysfunction after surgery for deep infiltrating endometriosis. J Minim Invasive Gynecol 2021; 28: 1544-1551 - 30 Mutuku T. Prä-operative Abschätzung einer tief infiltrierenden Darmendometriose mittels Untersuchungsbefund in der ENZIAN-Klassifikation und der Symptomatik sowie Vergleich mit dem intra-operativen ENZIAN-Befund; [The assessment of deep infiltrating endometriosis according to the preooperative investigation and symptoms in comparison to intraoperative findings with the ENZIAN-Classification] [MD Thesis]. Ulm: Universität Ulm; 2016

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Outcome instruments

Enzian

Condition tags

die_deep_infiltrating

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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