Ethanol Sclerotherapy in the Management of Ovarian Endometrioma: Technical Considerations for Catheter- and Needle-Directed Sclerotherapy

Aynur Azizova; Turkmen Turan Ciftci; Murat Gultekin; Emre Unal; Okan Akhan; Gurkan Bozdag; Devrim Akinci

doi:10.1007/s00270-024-03694-0

Ethanol Sclerotherapy in the Management of Ovarian Endometrioma: Technical Considerations for Catheter- and Needle-Directed Sclerotherapy

Cardiovasc Intervent Radiol. 2024 Mar 29. doi: 10.1007/s00270-024-03694-0. Online ahead of print.

Authors

Aynur Azizova¹, Turkmen Turan Ciftci¹, Murat Gultekin², Emre Unal¹, Okan Akhan³, Gurkan Bozdag², Devrim Akinci¹

Affiliations

¹ Department of Radiology, Hacettepe University School of Medicine, 06100, Sihhiye, Ankara, Turkey.
² Department of Obstetrics and Gynecology, Hacettepe University School of Medicine, 06100, Sihhiye, Ankara, Turkey.
³ Department of Radiology, Hacettepe University School of Medicine, 06100, Sihhiye, Ankara, Turkey. akhano@tr.net.

PMID: 38551784
DOI: 10.1007/s00270-024-03694-0

Abstract

Purpose: To provide technical guidance on applying catheter-directed and needle-directed ethanol sclerotherapy for endometriomas and present the results of these sclerotherapy methods.

Materials and methods: From January 2015 to March 2021, the results of the patients with symptomatic ovarian endometriomas who underwent needle-directed or catheter-directed sclerotherapy were evaluated, retrospectively. The decision to apply which sclerotherapy technique was made during the procedure for each patient considering the following factors: cyst size, cyst location, cyst viscosity, and tissue rigidity.

Results: Both needle-directed (n = 34 cysts) and catheter-directed (n = 34 cysts) sclerotherapy techniques were effective, with a 100% technical success rate and a 97% clinical success rate. In two of 34 cysts (6%) treated with needle-directed sclerotherapy, recurrence was detected and successfully retreated with catheter-directed sclerotherapy. Significant reductions in cyst size, pain, and serum cancer antigen 125 levels (p < 0.05) were noted. Serum anti-Müllerian hormone levels remained unaffected, indicating preserved ovarian reserve (p > 0.05). Among those treated for infertility, the pregnancy rate was 54% (n = 6/11). The mean ± SD cyst size decline was greater in catheter-directed sclerotherapy than needle-directed sclerotherapy (5.5 ± 3.1 cm vs. 4.0 ± 2.1 cm, p < 0.05). However, the pretreatment cyst volumes were considerably higher in catheter-directed sclerotherapy group (202.0 ± 233.5 mL vs. 78.8 ± 59.7 mL, p < 0.05) and were associated with significant post-treatment volume decrease (p < 0.05).

Conclusion: The choice between catheter-directed and needle-directed ethanol sclerotherapy should be determined during the procedure, with a preference for catheter-directed sclerotherapy when feasible. Crucial factors in making this decision include cyst size, cyst location, cyst viscosity, and tissue rigidity. Level of evidence Level 3, non-controlled retrospective cohort study.

Keywords: AMH; Dysmenorrhea; Endometriosis; Ethanol sclerotherapy; Infertility; Ovarian reserve.