A systematic review of ultrasonography-guided transvaginal aspiration of recurrent ovarian endometrioma.

Abstract

Ovarian endometriosis is present in 17%-44% of women with endometriosis. The main treatment is surgery, but ultrasonography-guided aspiration is a less invasive alternative. To evaluate the effectiveness of this alternative treatment in recurrent ovarian endometrioma. Multiple databases were searched for articles published between 1994 and 2014 using the keywords "ultrasound-guided aspiration," "ovarian," and "endometriosis." Randomized controlled trials and observational studies published in English, Portuguese, or Spanish were included. Two researchers independently extracted and reviewed the data. The main outcome of interest was the recurrence rate. Eight studies were eligible. Ovarian endometriosis is associated with high recurrence rates after one ultrasonography-guided aspiration (28.9%-91.5%), but involves less ovarian manipulation. The results of aspiration followed by sclerotherapy are not uniform, but overall the addition of a sclerosing agent does not seem to significantly reduce the likelihood of recurrence (13.3%-75.0%). Repeated aspiration of the cysts can reduce the recurrence rate to 5.4% by the sixth aspiration. Repeated ultrasonography-guided aspiration of ovarian endometriomas can be performed for the treatment of recurrent ovarian endometriosis. Further studies comparing the efficacy of this procedure and ovarian surgery are needed.