The 10 “Cardinal Sins” in the Clinical Diagnosis and Treatment of Endometriosis: a Bayesian Approach

Philippe R. Koninckx, Koninckx PR, Ussia A, Anastasia Ussia, Stephan Gordts, Gordts S, J. Keckstein, Keckstein J, Saridogan E, Ertan Sarıdoğan, Malzoni Mario, Mario M, Stepanian A, A.A. Stepanian, António Setúbal, Setúbal AG, L.V. Adamyan, Adamyan L, Arnaud Wattiez, Wattiez A
2023 · doi:10.20944/preprints202306.0970.v1 · W4380574610
preprint OA: green CC0 ⤵ 2 in-corpus citations
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-13 ⓘ

This paper identifies ten major challenges in endometriosis diagnosis and treatment, including diagnostic limitations, issues with medical and surgical therapies, and the need for improved surgical training and quality control.

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Abstract

Evidence-based data for endometriosis management are limited. Experiments are excluded without adequate animal models. Data are limited to symptomatic women and occasional observations. Hormonal medical therapy cannot be blinded if recognised by the patient. Randomised controlled trials are not realistic for surgery since a variable disease with low numbers. Each diagnosis and treatment is an experiment with an outcome and experience is Bayesian updating from the past. If the experience of many is similar, this has more value than an opinion. The combined experience of a group of endometriosis surgeons was used to discuss problems in the management of endometriosis. Considering endometriosis as several genetically/epigenetically different diseases is important for medical therapy. Imaging cannot exclude endometriosis and diagnostic accuracy is limited for superficial lesions, deep lesions, and cystic corpora lutea. Surgery should not be avoided for emotional reasons. Shifting infertility treatment to IVF without considering fertility surgery is questionable. The concept of complete excision should be reconsidered. Surgeons should introduce quality control and teaching should move to explain why it is done. The perception of information has a personal bias. These are the major problems in the management of endometriosis identified by the combined experience of endometriosis surgeons.

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endometriosisinfertility

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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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europepmc
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openalex
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