Ultrasound-guided sclerotherapy for the treatment of ovarian endometrioma: an updated systematic review and meta-analysis

Objective To determine the efficacy and safety of ultrasound (US)-guided sclerotherapy for the treatment of ovarian endometrioma through a systematic review and meta-analysis. Methods MEDLINE and EMBASE databases were searched for studies reporting outcomes in patients with endometrioma who were tre...

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Published in:European radiology 2022-03, Vol.32 (3), p.1726-1737
Main Authors: Kim, Gun Ha, Kim, Pyeong Hwa, Shin, Ji Hoon, Nam, In Chul, Chu, Hee Ho, Ko, Heung-Kyu
Format: Article
Language:English
Subjects:
Clinical trials
Diagnostic Radiology
Endometriosis - diagnostic imaging
Endometriosis - therapy
Ethanol
Female
Humans
Imaging
Internal Medicine
Interventional
Interventional Radiology
Medicine
Medicine & Public Health
Meta-analysis
Neuroradiology
Ovaries
Pain
Patients
Pregnancy
Pregnancy complications
Radiology
Sclerotherapy
Subgroups
Surgery
Systematic review
Ultrasonic imaging
Ultrasonography
Ultrasonography, Interventional
Ultrasound
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Summary:Objective To determine the efficacy and safety of ultrasound (US)-guided sclerotherapy for the treatment of ovarian endometrioma through a systematic review and meta-analysis. Methods MEDLINE and EMBASE databases were searched for studies reporting outcomes in patients with endometrioma who were treated with US-guided sclerotherapy. Meta-analyses of recurrence, pain resolution, pregnancy, technical success, and complication rates were analyzed. Subgroup analyses were conducted regarding the indwelling time of sclerotherapy (≤ 10 min vs > 10 min). Results Twenty-eight studies (1301 patients) were included. The pooled technical efficacy was 98.3%. The pooled estimates of recurrence, pain resolution, and pregnancy rate were 13.8%, 85.9%, and 37.6%, respectively. The pooled major complication rate was 1.7%. A sclerotherapy time > 10 min had a lower pooled recurrence rate than a time ≤ 10 min (11.2% vs 20.9%; p  = 0.106). Direct comparisons showed that the recurrence rate was significantly lower with sclerotherapy > 10 min than with sclerotherapy ≤ 10 min (OR, 0.2; p  = 0.015). Regarding pregnancy rates, sclerotherapy of > 10 min showed no significant difference compared with sclerotherapy of ≤ 10 min (35.9% vs 38.8%; p  = 0.664). Direct comparisons with surgery showed that sclerotherapy increased the pregnancy rate compared with surgery (OR, 2.0; p  = 0.042). There was no significant difference in AMH level before and after sclerotherapy ( p  = 0.951). There was no significant difference in major complication rates between sclerotherapy > 10 min and ≤ 10 min ( p  = 0.837). Conclusion US-guided sclerotherapy seems to be an effective and safe therapeutic option regarding recurrence, pain resolution, and pregnancy for patients with ovarian endometrioma. Key Points • US-guided sclerotherapy seems to be an effective and safe therapeutic option regarding recurrence, pain resolution, and pregnancy for patients with ovarian endometrioma. • Sclerotherapy of more than 10 min had a lower recurrence rate than sclerotherapy less than or equal to 10 min. There was no significant difference in major complication rates between sclerotherapy of  >  10 min and  ≤  10 min. • Future randomized controlled trials are warranted to compare the outcomes of US-guided sclerotherapy with surgery.
ISSN:0938-7994
1432-1084
DOI:10.1007/s00330-021-08270-5