basecamp module

basecamp section

Decision-making & counselling

video lecture

Mastering imaging in endometriosis 

Endometriosis is a chronic inflammatory disease with different treatment options. It occurs in women who can be either symptomatic or not (and when symptomatic with a variable range of severity) and may seek for pregnancy or not. To date, no preoperative factors have been found to identify patients who may respond better to surgical treatment of endometriosis [1]. As a result, ESHRE guidelines recommend to choose the most appropriate treatment option, according to symptoms and desire for future pregnancy, with a “shared decision-making approach” [1]. In this authoritative lecture, Prof. Renato Seracchioli reported some preoperative features, which can be used to identify women who can benefit from surgery, and to provide clinical cases for a surgically tailored management of endometriosis. First, a series of factors related to disease, patient and center, were identified as they are useful to define the expected benefits and potential disadvantages of the surgical treatment for each patient. Disease-related factors included endometriotic ultrasound features, ENZIAN/rASRM/AAGL stage; patient-related factors included symptoms (such as pain, bowel function, infertility), previous surgery (endometriosis or not), co-morbidities (CSS, dolichocolon), compliance to therapy, age; and center-related factors included a referred center for endometriosis, the surgeon’s experience, and the rate of complications in the referred center. More severe endometriosis has been associated with stronger pain relief after laparoscopic surgery and, consequently, some authors have proposed a pain score >7 (according to the Visual Analog Scale) as one of clinical criteria to choose surgery [2]. A higher prevalence of central sensitization has been reported among women with endometriosis; as a result, the identification of a central contribution to pain might preoperatively predict a poor pain response after surgery [3]. Surgery for endometriosis should be performed in a referred center where surgeons have experience with retroperitoneal dissection and nerve-sparing surgery [4], allowing to obtain a clinical benefit with a low surgical risk. In conclusion, age, individual preferences, desire for pregnancy, impact on quality of life (QoL) and symptoms, ultrasound features of endometriotic lesions, risk of surgical treatment have to be considered and balanced to build up the most appropriate surgical treatment.

Bibliography:

1. Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, King K, Kvaskoff M, Nap A, Petersen K, Saridogan E, Tomassetti C, van Hanegem N, Vulliemoz N, Vermeulen N; ESHRE Endometriosis Guideline Group. ESHRE guideline: endometriosis. Hum Reprod Open. 2022 Feb 26;2022(2):hoac009. doi: 10.1093/hropen/hoac009. PMID: 35350465; PMCID: PMC8951218.

2. Kho RM, Andres MP, Borrelli GM, Neto JS, Zanluchi A, Abrão MS. Surgical treatment of different types of endometriosis: Comparison of major society guidelines and preferred clinical algorithms. Best Pract Res Clin Obstet Gynaecol. 2018 Aug;51:102-110. doi: 10.1016/j.bpobgyn.2018.01.020. Epub 2018 Feb 16. PMID: 29545114.

3. Raimondo D, Raffone A, Renzulli F, Sanna G, Raspollini A, Bertoldo L, Maletta M, Lenzi J, Rovero G, Travaglino A, Mollo A, Seracchioli R, Casadio P. Prevalence and Risk Factors of Central Sensitization in Women with Endometriosis. J Minim Invasive Gynecol. 2023 Jan;30(1):73-80.e1. doi: 10.1016/j.jmig.2022.10.007. Epub 2022 Oct 29. PMID: 36441085.

4. Zakhari A, Mabrouk M, Raimondo D, Mastronardi M, Seracchioli R, Mattei B, Papillon-Smith J, Solnik MJ, Murji A, Lemos N. Keep Your Landmarks Close and the Hypogastric Nerve Closer: An Approach to Nerve-sparing Endometriosis Surgery. J Minim Invasive Gynecol. 2020 May-Jun;27(4):813-814. doi: 10.1016/j.jmig.2019.08.001. Epub 2019 Aug 3. PMID: 31386912.



Disclosures: Prof. Renato Seracchioli, MD, PhD has conflicts of interest to declare, receiving advisory board meeting fees and lecture fees from Medtronic, as well as lectures fees from Olympus. However, these industrial companies were never committed to the elaboration and running organization of Prof. Renato Seracchioli’s lectures and videos. There is neither commercial publicity nor commercial promotion in Prof. Renato Seracchioli’s lectures and videos. 

Prof. Renato Seracchioli, MD, PhD declares that he is fully committed to maintaining professional autonomy and independence in relation with the medical device industry. Prof. Renato Seracchioli has no financial affiliations that would affect the content of his presentations.

Clinical diagnosis, decision-making counselling in endometriosis

Improve your diagnostic work-up, decision-making, and counselling

Camp 1: Diagnostic work-up

Mastering imaging in endometriosis

Ultrasound diagnosis of endometriosis: eyes do not see what mind does not know (Part 1)

Ultrasound diagnosis of endometriosis: eyes do not see what mind does not know (Part 2)

MRI diagnosis of endometriosis: what a gynecologist needs to know