7736 Transcatheter Drainage and Ethanol Sclerotherapy for Treatment of Symptomatic Endometriomas: A Case Series

Abstract

<h3>Study Objective</h3> To investigate the efficacy of ethanol sclerotherapy for endometriomas as either pre-operative adjuvant therapy to facilitate minimally invasive surgery or as definitive treatment. <h3>Design</h3> This is a case series of 15 patients treated from 2010-2022 who presented with endometriomas causing bulk symptoms and pain. We reviewed pre-procedure imaging, surgical history, procedural findings, post-procedure treatment course and symptom changes, and most recent interval imaging if available. <h3>Setting</h3> Multidisciplinary academic complex gynecology center with multimodal imaging guidance. <h3>Patients or Participants</h3> Patient age range was 21-61 years. Five patients had a history of surgical resection for endometriomas. All patients had endometriomas diagnosed with CT or MR and associated symptoms including bulk and pain. <h3>Interventions</h3> Patients underwent image-guided transabdominal, transvaginal, or transgluteal catheter drainage of their endometriomas. The endometrioma was completely evacuated and contrast study was performed to determine cavity volume (for ethanol injection) and complete emptying of the cavity. Ethanol 100% was instilled two times with a dwell time of 5-7 minutes each and then evacuated. The median total volume of alcohol instilled was 100 cc (range 55-600 cc). The drain was usually left in place; patients returned at 24-96 hours for repeat contrast study and a third ethanol injection followed by catheter removal. <h3>Measurements and Main Results</h3> The median volume of endometriotic material drained was 200 cc (range 30-2000 cc). All patients reported symptomatic improvement immediately following the procedure. Interval imaging was available for 11 patients (interval length range 32-837 days) with an average reduction in volume of 83.5% (range 53.2%-100%). 6 patients underwent subsequent surgery for endometriomas. There was one complication – secondary infection requiring repeat drainage. <h3>Conclusion</h3> Ethanol sclerotherapy is an effective treatment for improving endometrioma symptoms and can delay or obviate the need for surgery. It should continue to be studied on a larger scale to ascertain its optimal role in endometrioma treatment.