Percutaneous Imaging-guided Cryoablation of Endometriosis Scars of the Anterior Abdominal Wall

Charlotte Jouffrieau, Jouffrieau C, Roberto Luigi Cazzato, Cazzato RL, Gabriele V, Victor Gabriele, Faller E, Emilie Faller, Émilie Faller, Weiss J, Julia Weiss, Host A, Aline Host, Garnon J, Julien Garnon, O. Garbin, Olivier Garbin, Garbin O, Afshin Gangi, Gangi A
Journal of Minimally Invasive Gynecology · 2023 · vol. 30(11) , pp. 890–896 · doi:10.1016/j.jmig.2023.06.018 · PMID:37422051 · W4383314804
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This study evaluated the efficacy and safety of percutaneous imaging-guided cryoablation for treating endometriosis scars in the anterior abdominal wall.

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Abstract

STUDY OBJECTIVE: To evaluate the safety and clinical efficacy of percutaneous imaging-guided cryoablation for the management of anterior abdominal wall endometriosis. DESIGN: Patients with abdominal wall endometriosis underwent percutaneous imaging-guided cryoablation and had a 6-month follow-up. SETTING: Data dealing with patients' and anterior abdominal wall endometriosis (AAWE) characteristics, cryoablation, and clinical and radiologic outcomes were retrospectively collected and analyzed. PATIENTS: Twenty-nine consecutive patients underwent cryoablation from June 2020 to September 2022. INTERVENTIONS: Interventions were performed under US/computed tomography (CT) guidance or magnetic resonance imaging (MRI) guidance. Cryoprobes were directly inserted into the AAWE, and cryoablation was performed with a single 5 to 10 minute freezing cycle, which was stopped when the iceball expanded 3 to 5 mm beyond AAWE borders as assessed on intra-procedural cross-sectional imaging. MEASUREMENTS AND MAIN RESULTS: Fifteen patients (15/29; 51.7%) had prior endometriosis, 28 (28/29; 95.5%) had previous cesarian section, and 22 (22/29; 75.9%) referred association between symptoms and menses. Cryoablation was performed under local (16/29; 55.2%) or general anesthesia (13/29; 44.8%) and mainly in an out-patient basis (18/20; 62%). There was only one (1/29; 3.5%) minor procedure-related complication. Complete symptom relief was recorded in 62.1% (18/29) and 72.4% (21/29) patients at 1 and 6 months, respectively. In the whole population, pain significantly dropped at 6 months compared to the baseline (1.1 ± 2.3; range 0-8 vs 7.1 ± 1.9; range 3-10; p <.05). Eight (8/29; 27.6%) patients presented residual symptoms at 6 months, and 4 (4/29; 13.8%) had an MRI-confirmed residual/recurring disease. Contrast-enhanced MRI obtained for the first 14 (14/29; 48.3%) patients of the series, all without signs of residual/recurring disease, demonstrated a significantly smaller ablation area compared to the baseline volume of the AAWE (1.0 cm3 ± 1.4; range 0-4.7; vs 11.1 ± 9.9 cm3; range 0.6-36.4; p <.05). CONCLUSION: Percutaneous imaging-guided cryoablation of AAWE is safe and clinically effective in achieving pain relief.

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Condition tags

endometriosis

MeSH descriptors

Abdominal Wall Abdominal Wall Abdominal Wall Abdominal Wall Abdominal Wall Abdominal Wall Abdominal Wall Abdominal Wall Abdominal Wall Abdominal Wall Abdominal Wall Abdominal Wall Abdominal Wall Abdominal Wall Abdominal Wall Abdominal Wall Abdominal Wall Abdominal Wall Abdominal Wall Abdominal Wall

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