When is see-and-treat hysteroscopic polypectomy successful?

Abstract

Objective(s): To identify factors associated with a successful see-and-treat hysteroscopic polypectomy.

Study design: We have retrospectively studied a population of 229 women with endometrial polyps who were referred to office hysteroscopy at the hysteroscopy unit of a large university hospital. See-and-treat polypectomy with 5-French microinstruments was routinely attempted. Cases where the endometrial polyp was successfully removed were compared to those who had to be referred to polyp resection with the resectoscope. Bivariate and multivariate statistical analyses where used to identify factors associated with the success of see-and-treat polypectomy.

Results: Outpatient hysteroscopy was feasible on 223 patients, confirming endometrial polyps in all of them. See-and-treat polypectomy with 5-French micro-instruments was successful in 65.5% of the cases (146/223). Bivariate analysis suggested an association of successful see-and-treat with younger age, lower BMI, premenopausal status, smaller polyps, easy hysteroscopic access and painless examinations. Multiple logistic regression confirmed the independent association of a successful see-and-treat polypectomy with premenopausal status (OR 3.623; 95%CI 1.302-10.084) and smaller polyp size (OR 0.891; 95%CI 0.846-0.938). Pain was confirmed as an independent, limiting factor (OR 0.085; 95%CI 0.034-0.214).

Conclusion: See-and-treat hysteroscopic polypectomy with 5-French instruments is effective and feasible but its success is lower in case of pain, larger polyps and postmenopausal patients.

Keywords: Endometrial polyps; Hysteroscopic surgery; Hysteroscopy; Outpatient hysteroscopy; See-and-treat hysteroscopy.