Management Of Endometrial Polyps Research Articles

Clinical pathway for diagnosis and management of endometrial polyps

子宫内膜息肉是常见的子宫内膜良性病变之一，可发生于青春期后的任何年龄，患病率随年龄增加而增高，其常见症状为异常子宫出血、不孕，或无明显症状。本临床诊疗路径以循证医学证据为基础，以临床规范诊疗为目的，建立从子宫内膜息肉高危因素的识别、临床诊断、病理分型到治疗再到患者的长期管理、宣教的诊疗流程路径，给予临床医师共识性的指导建议，旨在为广大妇产科医师提供子宫内膜息肉临床诊疗的可行性和规范性流程。.

Management of endometrial polyps in infertile women: A mini-review.

Considerable disagreement exists regarding whether endometrial polyps should be removed before attempting natural pregnancy and before pregnancy via intrauterine insemination (IUI) or in vitro fertilization (IVF). Through a literature review, we obtained information on the impact of endometrial polyps and polypectomy on fertility outcomes. Several observational studies have suggested that women with unexplained infertility may benefit from endometrial polypectomy for a future natural pregnancy. A few studies reported benefits from endometrial polypectomy in infertile women who plan to undergo IUI. However, no strong evidence supports polypectomy as a way to improve the pregnancy rate in infertile women who plan to undergo IVF or polypectomy during controlled ovarian stimulation for IVF. Although no studies have defined criteria for the polyp size that should be removed in infertile women, clinicians should be aware that small endometrial polyps (<10 mm) sometimes regress spontaneously. Endometrial polypectomy is currently justified in patients with repeated IVF failure, but more studies are needed to verify that endometrial polypectomy itself will eventually increase the pregnancy rate. Although several mechanisms by which endometrial polyps exert a negative effect on fertility have emerged, there is no consensus about the proper management of endometrial polyps in infertile women. Therefore, the management of endometrial polyps should be individualized depending on the patient's situation and clinician’s preference.

Hysteroscopic management of endometrial polyps and submucous leiomyomas in women using a levonorgestrel-releasing intrauterine system

Introduction This study was designed to evaluate the feasibility and effectiveness of hysteroscopy in the management of symptoms related to endometrial polyps and submucous leiomyomas in women using a levonorgestrel-releasing intrauterine system (LNG-IUS). Material and methods Twenty-three LNG-IUS users presenting with endometrial polyps and/or submucous leiomyomas and irregular uterine bleeding were recruited for hysteroscopic examination and surgery. Intrauterine pathology was investigated and treated by hysteroscopic resection with the LNG-IUS in situ, and the effect of the procedure on symptoms was evaluated after three to six months. Results Intrauterine pathology was successfully resected by hysteroscopy in 23 (100.0%) out of 23 cases. Following hysteroscopy, 18 (78.3%) women reported amenorrhea, one (4.3%) regular spotting, three (13.0%) irregular spotting and one (4.3%) patient resumed normal menstrual cycle. We conclude that 19 (82.6%) patients were postoperatively asymptomatic. All procedures were uncomplicated and 4 (17.4%) were carried out without general anesthesia as office procedures. Conclusion Endometrial polyps and submucous leiomyomas can develop in LNG-IUS users, and this can cause irregular uterine bleeding. Hysteroscopic resection of these pathologies is a feasible method in the clinical management of symptoms.

Management of endometrial polyps

The epidemiology of endometrial polyps is reported to be between 7.8 and 50% of women. The range remains quite broad and inconsistent due to confounding study factors such as the method of research, population studied, histological type and anatomical location of polyps. The development of polyps is influenced by a multitude of genetic and epigenetic factors. Chromosomes 6,7 and 12 are incriminated in this process. A fraction of these polyps may undergo malignant transformation, most commonly in postmenopausal patients. 3D ultrasound (US) and hysterosalpingo-contrast-sonography (HyCoSy) provide an accurate diagnosis and location of endometrial polyps (EPs). Expectant management is recommended when the polyp is up to 10mm in length, in asymptomatic young patients. When indicated, hysteroscopic removal of polyps can be performed as an outpatient without requiring a general anaesthetic. The use of a small tip diameter hysteroscope and 5Fr instruments offers safe, efficient and low-cost treatment. The hysteroscopic morcellator and shaver are the best surgical option for bigger polyps since it is a quick and time-effective method with the technique easily learned by surgeons.

31: Management of endometrial polyps with and without the intrauterine morcellator

31: Management of endometrial polyps with and without the intrauterine morcellator

The Role of the Mirena Intrauterine Device in the Management of Endometrial Polyps: A Pilot Study

To study the hypothesis that the levonorgestrel intrauterine device (LNG-IUD) can have a role in the treatment of endometrial polyps confirmed at outpatient hysteroscopy in premenopausal women. Canadian Task Force classification level II1 (a controlled trial that is not randomised). Outpatient hysteroscopy. Premenopausal women who had a polyp diagnosed at outpatient hysteroscopy. Premenopausal women who had a polyp diagnosed at outpatient hysteroscopy and had a LNG-IUD inserted were booked for general anesthesia hysteroscopy and polypectomy through the standard booking process. A contemporaneous control was taken sequentially from the outpatient hysteroscopy database to match the case. The presence of a polyp at hysteroscopy under general anesthesia. A total of 39 patients were included in the study, with 19 in the intervention group and 20 in the control group. The mean age was 43.6 (standard deviation = 5.6) and 43.2 (standard deviation = 8.1) years in the 2 groups, respectively. No difference was found in the time interval between the 2 procedures in the intervention and control groups (mean = 92 vs 84 days, p = .73). However, the proportion of polyps present at the second procedure was significantly higher in the control group (80% vs 37%; relative risk = 2.17; 95% confidence interval, 1.16-4.07; p = .0062). Our case-control study found that the LNG-IUD can have a role in the treatment of polyps for women who have heavy menstrual bleeding. This is the first study to show regression of endometrial polyps after treatment with LNG-IUD by direct visualisation at hysteroscopy.

Endometrial Polyp Size and the Risk of Malignancy in Asymptomatic Postmenopausal Women.

The appropriate management of endometrial polyps in asymptomatic postmenopausal patients remains controversial. The aim of the study was to evaluate the relationship between endometrial polyp size and malignancy risk among asymptomatic postmenopausal women. This observational retrospective study investigated 472 postmenopausal asymptomatic women who underwent hysteroscopic polypectomy between 2010 and 2014 (Canadian Task Force Classification II-3). Of the 472 women, premalignant and malignant lesions were found in 11 (2.33%) cases; four (0.84%) had endometrial carcinoma, and seven (1.49%) had atypical endometrial hyperplasia. The incidence of premalignant or malignant lesions among various cut-offs of polyp size (10, 15, 20 mm) was not significantly different. In the current series no significant risk factor for malignancy was found among different cut-offs of polyp size.

39: The use of the resectoscope in the management of endometrial polyps

39: The use of the resectoscope in the management of endometrial polyps

Hysteroscopy and treatment of uterine polyps

This article summarizes and analyzes the salient topics on the diagnosis and management of endometrial polyps, focusing on therole of the hysteroscopy. Noninvasive investigations such as transvaginal ultrasonography, with or without the use of three-dimensional ultrasonography (3D US) and contrast techniques, remain the mainstay of first-line investigation. Hysteroscopic resection represents the gold standard minimally invasive treatment for endometrial polyps. It is the most effective management and allows histologic assessment, whereas blind biopsy or curettage have low diagnostic accuracy and should not be performed.

Outpatient Hysteroscopic Polypectomy: Bipolar Energy System (Versapoint®) versus Mechanical Energy System (TRUCLEAR System®) - Preliminary Results

Hypothesis: The new hysteroscopic system with mechanical energy is an effective outpatient technique for diagnosis and treatment that has certain advantages over conventional hysteroscopy in the management of endometrial polyps. Objectives: Our primary objective was to assess the total duration of hysteroscopy and polypectomy performed in an outpatient setting comparing the new mechanical energy hysteroscopy to the bipolar energy system. Our secondary objective was to compare the level of safety of both hysteroscopic techniques using the procedure success rate, the need for subsequent referral to surgery, existing complications, and comfort experienced by the patient during the procedure. Patients and Methods: This randomized controlled trial included the first 90 patients with an ultrasound diagnosis of endometrial polyp (>1 cm) who underwent an outpatient diagnostic and operative hysteroscopy at the Igualada Hospital (Barcelona) and agreed to be included in the study by signing an informed consent. Results: We obtained a 91% success rate with the TRUCLEAR System® compared to a 69% success rate with the Versapoint® system. Total operating time was 6.36 min in the TRUCLEAR System group versus 10.82 min in the Versapoint system group (p < 0.05), with a polypectomy time of 3.06 and 7.91 min, respectively (p < 0.05). There were no significant differences between the two techniques when analyzing pain using the visual analogue scale. No complications were recorded for either technique. Conclusion: The mechanical energy system presents a significant decrease in the total duration of polypectomy and hysteroscopy when performed both by experienced staff and by staff in training, resulting in higher success rates without complications with respect to conventional hysteroscopy with bipolar energy.

A comparison of hysteroscopic mechanical tissue removal with bipolar electrical resection for the management of endometrial polyps in an ambulatory care setting: preliminary results.

To assess and compare efficacy, pain, and the learning curve associated with diagnostic therapeutic hysteroscopy using mechanical tissue removal versus bipolar electrical resection in the management of endometrial polyps in an ambulatory care setting. A randomized controlled clinical trial (Canadian Task Force classification I). Hospital de Igulada, Barcelona, Spain. A total of 133 patients diagnosed with endometrial polyp(s) were included and randomly assigned to 1 of the 2 hysteroscopic methods. Criteria assessed were total hysteroscopy time, full polypectomy procedure time, pain experienced by patients, and learning curve of staff in training. The average time to perform total hysteroscopy using the mechanical tissue removal system (TRUCLEAR 5.0 System; Smith & Nephew Inc., Andover, MD) was 6 minutes 49 seconds versus 11 minutes 37 seconds required for the bipolar electrosurgery system (GYNECARE VERSAPOINT; Ethicon Inc, Somerville, NJ) (p < .01). Results for complete polypectomy time favored the TRUCLEAR System at 3 minutes 7 seconds over the VERSAPOINT System at 8 minutes 25 seconds (p < .01). If a successful procedure is predicated on access to cavity, visualization, and complete resection and excision of endometrial polyp, the mechanical TRUCLEAR Tissue Removal System shows a higher success rate than the VERSAPOINT Bipolar Electrosurgery System at 92% and 77%, respectively. Analysis of pain using the visual analog scale revealed no significant differences between the 2 techniques (p > .05). A study of the residents' learning curve showed a higher level of autonomy with hysteroscopy using the TRUCLEAR Tissue Removal System with which residents showed a higher level of confidence compared with hysteroscopy with the VERSAPOINT Bipolar Electrosurgery System. In hysteroscopic polypectomy, the mechanical tissue removal system was significantly faster, achieved a greater success rate for complete polypectomy, and required a shorter learning curve from staff being trained in the management of endometrial polyps when compared with bipolar electrical resection.

Re. The management of endometrial polyps in the 21st Century

Re. The management of endometrial polyps in the 21st Century

The management of endometrial polyps in the 21st century

Key content Hysteroscopic endometrial polyp removal appears to be superior to the current practice of blind avulsion. Outpatient treatment is safe, cost effective and well tolerated, even in older or nulliparous women. New technologies facilitate office hysteroscopy. Benign endometrial polyps can regress and rarely progress to malignancy. Learning objectives To learn how to diagnose and treat endometrial polyps in pre and postmenopausal women. To be able to compare the performance of diagnostic modalities. To understand the role of outpatient vaginoscopy and hysteroscopy. Ethical issues Given the cost effectiveness and acceptability of office ambulatory diagnostic and interventional hysteroscopy, is it ethical not to offer such a service?

Levonorgestrel-releasing intrauterine system (LNG-IUS) as an effective treatment option for endometrial hyperplasia: a 15-year follow-up study

The levonorgestrel-releasing intrauterine system may represent an effective treatment option in >85% of endometrial hyperplasia cases, but histologic regression during and/or at the end of treatment does not assure stable recovery. We recommend periodic endometrial samplings for at least the first 2 years of follow-up and long-term clinical surveillance thereafter.

Sessile polyps and pedunculated polyps respond differently to oral contraceptives

Endometrial polyp is the lesion frequently found by hysteroscopy. The presence of endometrial polyp is associated with abnormal uterine bleeding and is probably associated with infertility. Until today, clinical guidelines for endometrial polyp remain elusive. The aim of this preliminary study was to estimate whether the shape of endometrial polyps affects the response to the treatment with an oral contraceptive (OC). We performed a retrospective case series study on 50 women diagnosed as endometrial polyps by hysteroscopy and managed by the administration of OC. Hysteroscopy was performed in the follicular phase of the menstrual cycle before medical treatment. Endometrial polyps were classified as pedunculated polyps (n = 25) or sessile polyps (n = 25). After diagnosis, OC was administered for 2–5 months (median 3 months) intermittently: To quantify the regression rate of lesions, the area index of endometrial polyps was assessed. In the study group, when comparing the efficacy of treatment with OC, there was a statistically significant difference in the regression rate between sessile polyps and pedunculated polyps (76% vs. 44%, p = 0.042). We conclude that sessile polyps are more sensitive to OC treatment than pedunculated polyps, implying usefulness of the hysteroscopic classification of the shape of polyps in the management of endometrial polyps.

The best management of endometrial polyps: a challenge to gynecologists

11 Professor associado do Departamento de Ginecologia e Obstetricia da Faculdade de Medicina de Ribeirao Preto - USP - Ribeirao P reto (SP), Brasil.Correspondencia: Francisco Jose Candido dos ReisDepartamento de Ginecologia e Obstetricia – Av. Bandeirantes, 3900 – 14049-900 – Ribeirao Preto – SP – Brasil.

Management of endometrial polyps: a clinical review

Endometrial polyps are common, increasing in incidence with age. They are also commoner in women with obesity and hypertension, and those treated with tamoxifen. They can be asymptomatic or can be associated with abnormal uterine bleeding. Diagnosis can be made with ultrasound or hysterosonography, but diagnostic hysteroscopy remains the gold standard is as it allows assessment of the rest of the uterine cavity. Although the risk of malignant transformation is low, the general consensus is that polyps should be removed. The most widely recommended method of removal is hysteroscopic resection. Long term follow up studies have shown that after polypectomy, symptomatic relief is greater in the older age group, so a causative role of polyps in abnormal uterine bleeding in younger women is questionable.

Management of endometrial polyps: Is surgery necessary?

Management of endometrial polyps: Is surgery necessary?

F226 Management of endometrial polyps in menopause patients under HRT

F226 Management of endometrial polyps in menopause patients under HRT