Treatment Of Endometrial Polyps Research Articles

Research Progress in the Treatment of Endometrial Polyps

Research Progress in the Treatment of Endometrial Polyps

Retracted: Multivariate Analysis of Recurrence after Hysteroscopic Diagnosis and Treatment of Endometrial Polyps following IVF-ET Failure.

[This retracts the article DOI: 10.1155/2022/4140022.].

Outpatient Hysteroscopic Polypectomy—A Retrospective Study Comparing Rigid and Semirigid Office Hysteroscopes

Endometrial polyps are one of the most common pathological conditions in gynecology. Hysteroscopy is the gold standard for the diagnosis and treatment of endometrial polyps. The purpose of this multicenter, retrospective study was to compare patients' pain perception during an operative hysteroscopic endometrial polypectomy in an outpatient setting with two different hysteroscopes (rigid and semirigid) and to identify some clinical and intraoperative characteristics that are related to worsening pain during the procedure. We included women that underwent, at the same time as an diagnostic hysteroscopy, the complete removal of an endometrial polyp (using the see-and-treat strategy) without any kind of analgesia. A total of 166 patients were enrolled, of which 102 patients underwent a polypectomy with a semirigid hysteroscope and 64 patients underwent the procedure with a rigid hysteroscope. No differences were found during the diagnostic step; on the contrary, after the operative procedure, a statistically significant greater degree of pain was reported when the semirigid hysteroscope was used. Cervical stenosis and menopausal status were risk factors for pain both in the diagnostic step and in the operative one. Our results confirm that operative hysteroscopic endometrial polypectomy in an outpatient setting is an effective, safe, and well-tolerated procedure and indicate that it might be better tolerated if a rigid rather than semirigid instrument is used.

Endometrial Polyps: Update Overview on Etiology, Diagnosis, Natural History and Treatment

Objectives: To provide an updated literature overview about the pathophysiology, natural history, diagnosis and treatment of endometrial polyps (EPs). Findings in Brief: EPs are focal, sessile or pedunculated projections of endometrial lining, resulting from the hyperplastic overgrowths of endometrial glands and stroma around a vascular core. These are the most common intrauterine diseases, affecting up to 34.9% of the women during their lifetime. EPs may vary in size, location, histopathology, natural history and clinical presentation. Importantly, EPs are common in women suffering with infertility (i.e., up to 32% in patients undergoing in-vitro-fertilization) and are not exempt from risk of malignant transformation (occurring in about 3.1% of patients). For these reasons, EPs represent one of the most significant gynaecological problems worldwide. Trans-vaginal ultrasound has fair diagnostic accuracy for EPs, with sensitivity and specificity of 91% and 90%, respectively. Nevertheless, the current gold standard for EPs diagnosis is hysteroscopy, which allows a direct visualization of EPs size and morphology. Moreover, this technique enables safe EPs excision, with a low risk of incomplete tissue removal (about 1.9% and 4.3% in inpatient and outpatient settings, respectively), and variable recurrence rate based on individual risk factors (ranging between 2.5% and 43.6%). Besides hysteroscopy, other management options for EPs can be considered on a case by case basis. Conclusions: Our review may be helpful for updating clinicians’ knowledge on the management of EPs.

Multivariate Analysis of Recurrence after Hysteroscopic Diagnosis and Treatment of Endometrial Polyps following IVF-ET Failure.

Objective To explore the risk factors affecting the recurrence of endometrial polyps (EPs) after hysteroscopic diagnosis and treatment of EPs following in vitro fertilization-embryo transfer (IVF-ET) failure by multivariate analysis. Methods The clinical data of 369 patients with EPs hysteroscopically treated in our department due to IVF-ET failure from January 2017 to January 2020 were retrospectively analyzed, including the number and size of polyps, postoperative treatment, endometriosis (EM), hydrosalpinx (HSP), and polycystic ovarian syndrome (PCOS), and the effects of these factors on EP recurrence were observed. Results Of the patients enrolled, 184 cases (49.9%) were treated by curettage, and 185 cases (50.1%) by electrotomy. A total of 72 cases (19.5%) of postoperative recurrence were determined, including 34 cases (9.2%) without postoperative medication, 31 cases (8.4%) with one month of postoperative Didroxyprogesterone (DG) administration, and 7 cases (1.9%) with three months of postoperative DG administration. Surgical methods, 3 months of postoperative medication, PCOS, and polyp number and size significantly influence the recurrence of EPs, which were all the influencing factors of polyp recurrence. After controlling for other factors, the risk of EP recurrence after electrotomy was found to be lower than that after curettage, with an odds ratio (OR) (95% confidence interval (CI)) of 0.354 (0.163–0.767); the risk of EP recurrence after 3 months of postoperative medication was lower than that without postoperative medication, with an OR (95% CI) of 0.024 (0.005–0.104); the risk of EP recurrence in patients with PCOS was higher than that without PCOS, and the OR (95% CI) was 2.505 (1.113–5.639); patients with multiple polyps (≥2) were at an increased risk of recurrence than those with a single polyp, with an OR (95% CI) of 66.552 (14.711–301.084); patients with polyp diameter ≥ 2 cm had a higher risk of recurrence than those with polyp diameter < 2 cm, and the OR (95% CI) was 1084.76 (148.743–7910.999). Conclusions PCOS patients are at an elevated risk of EP recurrence than non-PCOS patients. In patients with multiple polyps, those with a diameter ≥ 2 cm have an increased risk of polyp recurrence compared with those with polyp diameter < 2 cm; electrotomy is associated with a lower recurrence risk of EPs than curettage. The risk of EP recurrence in patients treated with postoperative progesterone for 3 months is lower than that of patients without postoperative medication.

Clinical Diagnosis of Endometrial Polyps Using Multioperator Algorithm Combined with Hysteroscopy

Exploring the effects of uterine imaging and hysteroscopy of endometrial polyps, this article has chosen the treatment effect of 50 cases of intrauterine polyps to observe hysteroscopy. The results showed that the diagnosis and sensitivity, specificity, positive, negative, and consistency were passed through various diagnostic methods ( P &lt; 0.05 ). The diagnostic sensitivity of antidiagnosis combination and series combination was 90.0%, 64.0%, 96.0%, 92.0%, 80.0%, 80.0%, 88.0%, and 92.0%, parallel diagnosis with high sensitivity, significantly higher than simple diagnosis ( P &lt; 0.05 ). Therefore, in the clinical treatment of endometrial polyps, hysteroscopic surgery is a safe and effective treatment, which can remove endometrial quality, improve the clinical symptoms of patients, and reduce the interference and postoperative recovery process of surgical trauma.

Evaluation of the efficacy and adverse reactions of hysteroscopy in the treatment of endometrial polyps.

Evaluation of the efficacy and adverse reactions of hysteroscopy in the treatment of endometrial polyps.

Too big? A review of methods for removing large endometrial polyps in office minihysteroscopy - broadening the indications for the procedure in the COVID-19 pandemic.

Hysteroscopy is the gold standard for the diagnosis and treatment of endometrial polyps. For small polyps (less than 2 cm) minihysteroscopy can be performed in an office setting. Patients with polyps larger than 2 cm are usually referred for a standard resectoscope procedure in the operation room (OR) under general anaesthesia. Those patients are exposed to longer hospital stay and possible complications of the anaesthesia. Furthermore, they usually have longer contact with many medical staff members. Limiting the time of contact as well as the number of staff involved in the procedure is particularly important during the COVID-19 pandemic. For this reason, minihysteroscopy in an office setting should be the first choice in every possible indication. We present the methods that may be useful for removing even large polyps in minihysteroscopy. The advantages and disadvantages of every procedure are discussed.

A prospective, open-label, single-arm study to evaluate the efficacy of dydrogesterone in the treatment of endometrial polyps

Object To evaluate the efficacy of dydrogesterone for the treatment of premenopausal patients with endometrial polyps (EPs). Methods A single-center, open-label, prospective, single-arm clinical treatment trial was conducted in patients of reproductive age with EP(s). Patients were prescribed dydrogesterone from day 15 to day 24 of the menstrual cycle over a period of 3 months. At the 3-month follow-up, the efficacy of dydrogesterone was evaluated based on changes in self-report symptoms and ultrasonographic characteristics. The predictive factors of efficacy as well as the predictive value of the significant factors were also assessed. Results A total of 60 patients were included. Improvements in both symptoms and ultrasound findings occurred in 31 patients, achieving an efficacy rate of 51.67%. Of 41 patients with clinical presentations, 39 (95.1%) reported improvements in symptoms. In terms of ultrasound findings, 33 (55%) of patients demonstrated improvements. Significant decreases were observed in the mean endometrial thickness (1.17 ± 0.33 cm vs 0.90 ± 0.35 cm, p < .001) and polyp size (1.10 ± 0.34 cm vs 0.74 ± 0.65 cm, p = .001) after the application of dydrogesterone. Age (p = .006), polyp size (p = .006), and blood flow within polyps (p = .035) were significant predictors of dydrogesterone efficacy. These factors, when combined, demonstrated a good predictive value ([area under the curve (AUC)=0.81]). Conclusion Dydrogesterone is effective in the management of EPs in premenopausal patients. Age, polyp size and blood flow should be taken into consideration when prescribing dydrogesterone for this population of women.

Ultrasonic Imaging Combined with Hysteroscopy in Diagnosis of Endometrial Polyps Based on Multioperator Algorithm and Analysis of Nerve Growth Factor Receptor Transmembrane Protein Expression

The paper aims to understand the expression of nerve growth factor receptor (TrkA) in the ectopic and entopic endometrium of patients with adenomyosis and dysmenorrhea and, at the same time, explore and analyze the combination of hysteroscopy and ultrasound imaging based on multioperator algorithms. The clinical treatment value of color Doppler ultrasound in the diagnosis and treatment of endometrial polyps. The immunohistochemical avidin-peroxidase staining method (SP method) was used to detect 20 cases of ectopic endometrium and entopic endometrium in patients with dysmenorrhea of adenomyosis (study group) and 22 cases of uterine fibroids in the control group. The expression of nerve growth factor receptor in the endometrium of patients with dysmenorrhea and comparative analysis. At the same time, all patients were examined by transvaginal color Doppler ultrasound and hysteroscopy. The scores of endometrial polyps, diagnostic efficiency of the methods, and receiver operating characteristic curve analysis of various diagnostic methods were observed and recorded in the 2 groups. There was no significant difference in the expression of TrkA in the ectopic endometrium and the entopic endometrium in the study group (P > 0.05), but the expression intensity of TrkA in the 2 groups was significantly higher than that in the control group (P = 0.05). In the diagnosis of endometrial polyps, the area of receiver operating characteristic curve in the parallel combined diagnosis of ultrasound and hysteroscopy is significantly larger than that under the combined diagnosis of series. TrkA is widely expressed in the ectopic and entopic endometrium of patients with adenomyosis and dysmenorrhea and may play an important role in the onset of adenomyosis and dysmenorrhea. Hysteroscopy combined with color Doppler ultrasound can effectively improve the diagnostic accuracy of patients with endometrial polyps.

Результати лікування хворих з поліпами ендометрія при застосуванні диференційованого підходу

The problem of treatment of endometrial polyps remains relevant, because it has high risks of malignancy and a steady tendency to increase the frequency of relapses and is inherent from 26 to 78% in women of different age categories. The objective: is to reduce the frequency of relapses of endometrial polyps by introducing a differentiated treatment strategy for patients with endometrial polyps based on the study of new pathogenesis links. Materials and methods. Clinical and laboratory examinations and treatment of 66 women diagnosed with endometrial polyp at the age of 24–43 years were carried out, which were further divided into two statistically equivalent groups: A (n=34) and B (n=32). All women received treatment according to the 4-stage algorithm of the current order of the Ministry of health of Ukraine No. 676 dated 31.12.2004. The difference in the management of group A patients was that their treatment was supplemented by immunomodulate therapy. At the first stage of the study, additional hysteroresectoscopy was performed, endometrial samples were obtained to determine its type of pathology, develop an immunohistochemical profile of the endometrium with the establishment of a receptor phenotype, identify the inflammatory process, and determine the state of the apoptosis system and the APUD system of the endometrium. Results. Active histological screening of the endometrial condition showed that signs of chronic endometritis (positive reaction of CD-138 and CD-68 markers) in women with endometrial polyp with physiological background endometrium were observed in 26.5% of group A patients after 3 months of treatment, which required a repeat course of treatment based on the results of viral and bacteriological examination. In group B, this rate was 46.9%. All the examined women, against the background of the use of gestagens, showed changes in the endometrial receptor phenotype, which were manifested by a decrease in the number of progesterone receptors in the glandular epithelium by an average of 1.4 times. However, the expression levels of Bcl-2 protein and EC cells had no statistical differences, since there were no signs of proliferation in the background endometrium, including local ones. Viral-bacterial screening of the study showed a sharp decrease in the number of pathogens in the endometrium, but in studies of patients of both groups, viral-bacterial associations were determined. Bacterial screening revealed the presence of anaerobic microflora. The study of the level of tumor necrosis factor in flushes from the uterine cavity indicated a unidirectional trend with the dynamics of the CD-138 index. The results of treatment of patients with endometrial polyp with physiological endometrium showed that the full effect of treatment in group A (antibacterial therapy with gestagens + immunomodulatory therapy) was determined after a year in 85.2% of patients, 14.8% of women had a relapse of endometrial polyp, in the group where patients received only antibacterial therapy with gestagens – a relapse was diagnosed in 37.5% of patients. Conclusion. Determining the tactics of differentiated treatment of endometrial polyps, it is necessary to take into account the results of immunohistochemical research and viral-bacterial control of the endometrial condition, which allows improving the results of treatment of endometrial polyps from 62.5% to 85.2 %, and is a prevention of relapse of endometrial polyp. Key words: endometrial polyps, hysteroscopy, endometrial immunohistochemical examination, apoptosis system, endometrial APUD system, viral-bacterial screening.

Полипы эндометрия в постменопаузе. Место электромеханической морцелляции в лечении полипов эндометрия

Полипы эндометрия в постменопаузе. Место электромеханической морцелляции в лечении полипов эндометрия

Оптимизация диагностики и лечения полипов эндометрия у пациенток

Оптимизация диагностики и лечения полипов эндометрия у пациенток

Hysteroscopic Resection of Endometrial Polyps and Assisted Reproductive Technology Pregnancy Outcomes Compared with No Treatment: A Systematic Review

Endometrial polyps are frequently encountered in the uterine cavity of infertile women. There is much debate regarding the treatment of endometrial polyps in patients who are undergoing assisted reproductive technology (ART). A systematic review was performed by searching PubMed, Embase, and the Cochrane Library for retrospective or prospective studies that compared the effect of hysteroscopic resection of polyps with no treatment on pregnancy outcomes of patients who underwent ART. The primary outcomes were clinical pregnancy, live birth, miscarriage, and implantation rates after ART. Eight studies with a total of 2267 patients were included. The results showed that hysteroscopic resection of endometrial polyps (mean size <2 cm) was associated with an increased rate of clinical pregnancy in patients who underwent intrauterine insemination. No clear benefit was observed for clinical pregnancy, live birth, miscarriage, or implantation rates in patients who underwent in vitro fertilization/intracytoplasmic sperm injection cycles. In conclusion, the effect of hysteroscopic polypectomy on pregnancy outcomes of patients who have undergone ART remains unclear. More prospective, randomized controlled trials are warranted to determine appropriate treatment.

Post hysteroscopic progesterone hormone therapy in the treatment of endometrial polyps.

Objective:To find out the clinical effects of post hysteroscopic progesterone hormone therapy in the treatment of endometrial polyps in terms of clinical outcome and the expression of endometrial Vascular Endothelial Growth Factor (VEGF).Methods:Ninety-eight patients who were confirmed as endometrial polyp in the hospital from April 2014 and December 2016 were selected and divided into treatment group and a control group using random number table, 49 in each group. Patients in both groups were given hysteroscopic operation. Patients in the treatment group were treated by progesterone hormone drugs after hysteroscopic operation, while patients in the control group were not given progesterone hormone. The changes of menstrual blood volume, menstrual cycle and expression of VEGF were compared between the two groups after treatment, and the recurrence condition, thickness of endometrium and hemoglobin were followed up one year after treatment.Results:The pictorial blood loss assessment chart (PBAC) scores of patients in the two groups had no significant difference before treatment (P>0.05); but the score of the treatment group was much lower than that of the control group. The improvement rate of menstrual cycle of the treatment group was much higher than that of the control group, and the difference had statistical significance (P<0.05). Compared to before treatment, the serum VEGF level of the patients in both groups had a remarkable decline in the 1st, 3rd and 6th month after treatment, and the difference had statistical significance (P<0.05). The difference of the serum VEGF level between the two groups in the 1st and 3rd month after treatment had no statistical significance (P>0.05). The serum VEGF level of the treatment group was notably lower than that of the control group six months after treatment, and the difference had statistical significance (P<0.05). The follow-up results demonstrated that the treatment group had smaller thickness of endometrium and higher level of hemoglobin compared to the control group, and the recurrence rate of the treatment group was lower than that of the control group (P<0.05).Conclusion:Post hysteroscopic progesterone hormone therapy has favorable clinical effect in treating endometrial polyps as it can effectively prevent the recurrence of endometrial polyps, relieve the level of hemoglobin and reduce endometrial thickness.

Endometrial polyps: new strategies for effective treatment

The work is devoted to the issue of effectiveness improvement in treatment of endometrial polyps (EP) in women of reproductive age.Study objective: to evaluate the clinical efficacy of the Allokin-alpha in combination with dydrogesterone for the treatment of EP in women of reproductive age.Study design: the study involved 70 patients aged 18–35 years: 34 patients with EP (group I), 30 patients with EP and chronic endometritis (CE) (group II) and 30 patients of the control group (group III). Subgroup Ia (n = 15) received dydrogesterone for the treatment, Ib (n = 19) – dydrogesterone and Allokin-alpha, IIa (n = 17) – dydrogesterone and antibiotic, IIb (n = 19) – dydrogesterone, antibiotic and Allokin-alpha.Study methods: group I and II were diagnosed by hysteroscopy with histological confirmation, endometrial samples from healthy women were obtained by aspiration biopsy. Bacteriological examination of the endometrium was performed by PCR and by cultivating aerobic and anaerobic microorganisms on special growth media. The endometrial sections were immunostained with monoclonal antibodies against the specific markers of plasmacytes (CD138), NK cells (CD56, CD16), cellular marker for proliferation (Ki-67).Study results: Endometrial samples of women with EP (isolated or in conjunction with CE) were characterized by significantly higher detection of Candida spp. – 21% (p = 0,012), and Herpes viruses type 1, 2, and 6 – 17% (p = 0,016). Compared with the normal endometrium, isolated EP contained a lower density of CD56 and CD16, EP in conjunction with CE had a higher density of CD138 along with a lower density of CD16.Dydrogesterone therapy in combination with Allokin-alpha was effective in correcting local immune disorders in the endometrium, normalizing proliferative processes and eliminating infectious agents in the uterine cavity.

Feasibility of hysteroscopic endometrial polypectomy using a new dual wavelengths laser system (DWLS): preliminary results of a pilot study.

Currently, endometrial polyps may be successfully treated in an outpatient setting with 5 Fr mechanical and bipolar instruments. Our aim is to evaluate the benefits of minimally invasive techniques in hysteroscopy, focusing on the use of a new dual wavelengths laser system in the treatment of endometrial polyps in an outpatient setting. Between September 2012 and December 2014, all consecutive patients of reproductive and menopausal age with ultrasound diagnosis of endometrial polyp with maximum diameter ≤2.5cm were eligible to participate in a prospective study. They underwent a hysteroscopic procedure with excision of the polyp using a new dual wavelengths laser system. All procedures were performed on an outpatient basis without anesthesia. Laser polypectomy was successfully performed in 219 out of 225 (97.3%). Success of surgery was not influenced by the initial location of polyp. No main complications were reported during or immediately after the procedure. 6 and 12months follow-up with ultrasound scan did not show any persistence or recurrence of the pathology. Our preliminary findings seem to support the safety and the effectiveness of the laser hysteroscopic endometrial polypectomy. However, further studies are mandatory to validate its use in daily hysteroscopic practice.

“See and treat hysteroscopy” in the management of endometrial polyp

Aims: The development and refinement of instruments and equipment led to the progressive use of “see and treat hysteroscopy” (HY), as a reliable alternative to the operative hysteroscopy (OHy) in the treatment of endometrial target lesions. We carried out a prospective study with the aim of evaluate the effectiveness and feasibility of HY for the treatment of endometrial polyps (EPs) in women complaining for abnormal uterine bleeding (AUB). Methods: All the patients (pt) admitted to our Institution were submitted to HY, if a suspicion of EP at the ultrasound assessment was reported in women complaining for AUB. Variables related to the surgical procedure and the patients’ compliance were registered. The pain was measured with NRS scale and defined as the pain felt during and up to 3 h after the procedure (perioperative pain). Results: Overall 219 pts were enrolled. 93.2% of EPs was radically removed by HY without any major surgical complications (bleeding or uterine perforation). The mean duration of HY was 15 min. 13.3% of the pts had to be submitted to more than one procedure because of EPs dimensions (23.28 mm ± 15.7 DS versus 13.6 mm ± 8.8 DS, p = 0.0001) or numbers (1.59 ± 1.0 DS versus 1.22 ± 0.4 DS; p = 0.003). OHy was performed in the 6.8% of the pts initially submitted to HY; major reasons were patient's choice (6/15 pt, that is 2.7% of overall population) or intraoperative vasovagal reaction (4/15 pt, that is 1.8% of overall population). No differences were reported between HY and OHy in EPs mean diameter (14.9 mm ± DS 10.6 vs. 18 mm ± DS 9.6, p 0.5) or numbers (1.25 ± DS 0.6 vs. 1.07 ± 0.3, p 0.6). Perioperative pain resulted as feeble or mild pain according to NRS pain score in 61.2% of the patients; overall mean NRS was 5.5 ± DS 2. Women with a previous vaginal delivery (32.5% versus 16.7% of nulliparae, p 0.01) or taking progestins as a concomitant therapy (77.8% versus 38.7% without therapy, p 0.01) judged more commonly as feeble the perioperative pain. Conclusions: Immediate HY is a fast, effective and feasible outpatient surgical procedure in the treatment of EPs, regardless their numbers or dimensions. The diffusion of HY could reduce patient's hospital admission and OHy's indications, without reducing the quality of treatment and histological specimen. Immediate HY could speed up the diagnostic management of EPs in women with AUB. Progestins therapy may improve intraoperative pain, because of their uterine cervical muscle relaxant and anti-inflammatory properties.

High prevalence of endometrial polyps in endometriosis-associated infertility

In a retrospective study, examination of 431 infertile women (158 cases with endometriosis and 273 without endometriosis) showed a significantly increased frequency of endometrial polyps in patients with endometriotic infertility and no significant differences among different stages and locations of endometriosis. Hysteroscopic polypectomy and removal of endometriotic foci significantly increased the chances of achieving a pregnancy compared with those without polyps.

Treatment of Endometrial Polyps – A Systematic Review

Background. Transcervical resection of endometrial polyps is usually performed in order to exclude atypic and/or malignant endometrial changes, to relieve abnormal uterine bleeding or to improve infertility. Objective. To systematically explore the rationale of transcervical polyp resection. Search strategy. Electronic searches of MEDLINE, EMBASE and The Cochrane Library. Selection criteria. Studies reporting the prevalence of premalignant and/or malignant tissue changes within endometrial polyps, as well as outcomes of endometrial polyp removal in terms of symptom relief and improved fertility were included. Main results. 46 studies met the criteria for inclusion (malignancy: 20 studies including 9,266 women, symptom relief: 15 studies including 1,034 women, infertility: 11 studies including 935 women). Most studies were uncontrolled retrospective case series. Only two randomized controlled trials were identified. The prevalence of premalignant and malignant tissue changes within endometrial polyps varied in the included studies, 0.2–23.8% and 0–12.9%, respectively. Postmenopausal symptomatic women appeared to have the highest risk of premalignant and malignant tissue changes. The effect of polypectomy on periodic blood loss appeared to be questionable, but all studies measuring the effect of polypectomy by general terms such as improved/not improved reported a favorable outcome (75–100% success rate). Polypectomy appears to have a favorable outcome in infertile women. Conclusions. The evidence which substantiates the removal of endometrial polyps is limited, and future research evaluating the outcome of this common procedure is required. Based on the available evidence, however, we provide recommendations for treatment of women with endometrial polyps.