Die Enzian-Klassifikation und ihre klinische Bedeutung

Objective: To assess the extent to which the Enzian classification correlates with the revised American Society for Reproductive Medicine (rASRM) score and clinical symptoms in patients with deeply infiltrating endometriosis. Design: Retrospective cohort study (Canadian Task Force classification II-2). Setting: Endometriosis competence center specializing in minimally invasive surgery. Patients: Between January 1st, 2009 and December 31st, 2011, a total of 194 patients underwent surgery due to deeply infiltrating endometriosis. After histological confirmation, they were classified using the rASRM and Enzian systems. Clinical symptoms were recorded preoperatively. Interventions: Operative laparoscopy to treat endometriosis. Main outcome measures and results: A clear correlation was seen between grades of severity in the rASRM score and the Enzian classification (P < 0.001). In addition, the rASRM severity grade and clinical symptoms correlated strikingly with the locations in the Enzian classification in relation to deeply infiltrating endometriosis. Pain and dysmenorrhea correlated strongly (P = 0.002, P < 0.001) with the severity grade in the Enzian classification. Conclusions: Deeply infiltrating endometriosis is well characterized using the Enzian classification as a supplement to the rASRM score. There is also a clear correlation between the rASRM and Enzian classifications, due to the way in which the disease crosses morphological boundaries. The locations in the Enzian classification correlate partially with clinical symptoms, and the classification’s severity grades correlate substantially with pain and dysmenorrhea. In view of these clinical results, use of the Enzian classification can be recommended as a supplement to the rASRM score for detailed description of endometriosis.