Size Matters: In-Office Hysteroscopy and Successful Removal of Endometrial Polyp [ID 2683670

Abstract

INTRODUCTION: Hysteroscopy serves as the gold standard for investigating intrauterine pathologies. Previous studies suggest successful in-office hysteroscopic polypectomy in younger, lower body mass index, premenopausal patients with smaller polyps and painless examinations. We share our in-office hysteroscopic polypectomy experience and aim to determine the threshold for estimated polyp size on ultrasound imaging most associated with successful in-office removal. METHODS: We conducted a retrospective study at a single urban hospital, including all patients who underwent in-office hysteroscopy (IOH) between December 2018 and April 2023. Using standardized protocols, we employed vaginoscopy no-touch techniques with a 5-mm diagnostic hysteroscope (30-degree optic) using normal saline for distension without anesthesia. Polyps were removed using hysteroscopic instruments. Preoperative ultrasound reports provided initial polyp diameter, which was subsequently correlated with intraoperative hysteroscopic impression and postoperative pathology reports. RESULTS: One hundred forty patients underwent IOH. Among them, 53 (38%) were referred for suspected endometrial polyps identified on ultrasound. 10 patients were excluded from the study: 6 lacked available imaging, 2 showed no polyps on imaging, and 2 had unsuccessful entry due to cervical stenosis. Successful entry into the endometrial cavity was achieved in 95.3% of cases, with cervical stenosis and pain as limiting factors. 13.9% (6 patients) experienced failed in-office polypectomy due to large polyp size (mean estimated diameter: 2.23 cm). CONCLUSION: In-office hysteroscopy using the vaginoscopy no-touch technique is a highly advantageous therapeutic modality for managing patients with endometrial polyps. Polyps larger than 2 cm pose challenges, often leading to unsuccessful in-office removal.