Sclerotherapy for Ovarian Endometriomas
What does this treatment involve?
Ovarian Cysts and Endometriosis
Endometriosis is a disease in which tissue similar to the tissue of the endometrium (the inner lining of the uterus) grows outside the uterus. This tissue, which is sensitive to hormones, grows much like the endometrium inside the uterine cavity: it thickens during the first half of the menstrual cycle, then bleeds during menstruation.
But the body cannot eliminate this blood, which therefore stagnates and causes lesions to form, in some cases leading to cysts. These cysts are called ovarian endometriomas, endometrial ovarian cysts or “chocolate cysts.”
Ovarian cysts can form on one or both ovaries. They are usually between 3 and 5 cm in diameter. However, the smallest cysts might be only a few millimeters in diameter, while the largest may measure up to 15 cm.
Ovarian cysts cause considerable pain during menstruation, but that’s not all: symptoms are similar to those of endometriosis and may include urinary issues, sporadic bleeding, pain during intercourse and infertility.
How is Sclerotherapy Used to Treat Ovarian Endometriomas?
To remove an endometrial cyst, the gold standard treatment is the surgical ablation of the cyst. However, this method puts healthy ovarian tissue at risk and may impact fertility.
Cyst aspiration, in which the cyst is drained, is another method. Less invasive than ablation, it carries a high risk of recurrence.
For cysts smaller than 15 cm, a completely different option is now available, known as sclerotherapy, or percutaneous ethanol injection (PEI). This minimally invasive technique is used to treat endometrial cysts by injecting alcohol (ethanol) warmed to 95°C into the cysts.
Although the PEI method is not widely practiced, it offers good results. It can be used to eliminate the cyst without damaging the ovarian tissue. Because it is a minimally invasive procedure, the associated risks are low. The recurrence rate is also much lower than with aspiration.
What to Expect During an Ovarian Endometrioma Sclerotherapy Procedure at the American Hospital of Paris
Percutaneous ethanol injection to treat ovarian endometriomas is performed by our interventional radiologists. These specialists, trained in France’s top teaching hospitals, use leading edge medical equipment at the American Hospital of Paris to ensure your procedure is safe and effective.
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Procedure
Ovarian endometrioma sclerotherapy is performed in an interventional radiology room. Once the area to be treated has been identified using imaging technology, local anesthesia is administered.
Next, working under ultrasound guidance, the interventional radiologist inserts a needle into the cyst. He or she removes the fluid from inside the cyst then cleans the inside by injecting an ethanol solution. You might feel very light pain at this time.
Lastly, the radiologist applies pressure to the puncture site and places a bandage over it.
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Duration of the procedure
Injecting ethanol into ovarian cysts is a quick procedure. It lasts between 30 minutes and an hour and is performed on an outpatient basis.
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Postoperative follow-up
After the procedure, you will remain under observation for two hours. Our health care professionals will provide the necessary follow-up care and monitoring.
Once we are certain that everything went smoothly, you will be allowed to go home. You will not have a scar or any postoperative pain.
You can resume your regular activities the very next day.
After you are discharged, your medical team is available 24/7 via a hotline to answer any questions you may have. It is important that you contact us quickly if you experience persistent pain or any abnormal symptoms such as dizziness, fever or shivering.
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Cost and coverage
The procedure is covered by the French national health insurance (sécurité sociale). Physician fees are determined with tact and moderation.
How to Prepare For a Sclerotherapy Procedure to Treat Ovarian Endometriomas
Injecting ethanol into ovarian cysts is a minimally invasive procedure that requires no particular preparation.
When you come for your preoperative consultation, please bring the following:
· Imaging reports;
· Lab reports;
· Blood test results;
· List of your medications.
What Are the Outcomes of Sclerotherapy for Ovarian Endometriomas?
Sclerotherapy for ovarian endometriomas is an effective, low-risk, minimally invasive outpatient procedure that does not leave a scar. It is used to remove cysts from the ovary while preserving ovarian function and fertility. In addition, the risk of recurrence is very low.
Recent studies show:
- It is a safe and effective treatment for endometriomas measuring 4 to 10 cm in diameter [1];
- It results in a significant decrease in cyst diameter while preserving ovarian function [2].
What are the Side Effects of Sclerotherapy for Ovarian Endometriomas?
The injection of ethanol into ovarian cysts is a very low-risk technique. Complications are rare. At the American Hospital of Paris, our practitioners take all of the necessary precautions to reduce potential complications to a minimum.
The main side effects of this procedure are:
- Bruising at the puncture site;
- Temporary pain (relieved by painkillers)
- Risk of infection.
Key figures
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176 million
Number of women of child-bearing age with endometriosis, worldwide.
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17 to 44%
Percentage of women with endometriosis who have ovarian cysts.
Sources & crédits
Références :
1. Ethanol sclerotherapy of ovarian endometrioma: a safe and effective minimal invasive procedure. Preliminary results https://pubmed.ncbi.nlm.nih.gov/25739052/
2. Catheter-directed Sclerotherapy for Ovarian Endometrioma: Short-term Outcomes https://pubs.rsna.org/doi/10.1148/radiol.2018180606
Key figures : https://www.academie-medecine.fr/wp-content/uploads/2021/11/21.11.9-Rapport-endometriose.pdf
