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When more is not better: 10 ‘don’ts’ in endometriosis management. An ETIC* position statement
| Content Provider | Semantic Scholar |
|---|---|
| Author | Alio, Luigi Angioni, Stefano Arena, Saverio Bartiromo, Ludovica Bergamini, Valentino Berlanda, N. Bonin, Cecilia Busacca, Mauro Candiani, Massimo Centini, Gabriele Alterio, Maurizio Nicola D’ Cello, Annalisa Di Exacoustos, C. Fedele, Luigi Frattaruolo, Maria Pina Incandela, Domenico Lazzeri, Lucia Luisi, Stefano Maiorana, Antonio Maneschi, Francesco Martire, Federico Massarotti, Claudia Mattei, Alexandra Muzii, Ludovico Ottolina, Jessica Perandini, Alessio Perelli, Federica Pino, I. Porpora, Maria Grazia Raimondo, Daniele Remorgida, Valentino Seracchioli, Renato Solima, Eugenio Somigliana, Edgardo Sorrenti, Giusi Venturella, Roberta Vercellini, Paolo Viganò, Paola Vignali, Mario Zullo, Fulvio Zupi, Errico |
| Copyright Year | 2019 |
| Abstract | A network of endometriosis experts from 16 Italian academic departments and teaching hospitals distributed all over the country made a critical appraisal of the available evidence and definition of 10 suggestions regarding measures to be de-implemented. Strong suggestions were made only when high-quality evidence was available. The aim was to select 10 low-value medical interventions, characterized by an unfavorable balance between potential benefits, potential harms, and costs, which should be discouraged in women with endometriosis. The following suggestions were agreed by all experts: do not suggest laparoscopy to detect and treat superficial peritoneal endometriosis in infertile women without pelvic pain symptoms; do not recommend controlled ovarian stimulation and IUI in infertile women with endometriosis at any stage; do not remove small ovarian endometriomas (diameter <4 cm) with the sole objective of improving the likelihood of conception in infertile patients scheduled for IVF; do not remove uncomplicated deep endometriotic lesions in asymptomatic women, and also in symptomatic women not seeking conception when medical treatment is effective and well tolerated; do not systematically request second-level diagnostic investigations in women with known or suspected non-subocclusive colorectal endometriosis or with symptoms responding to medical treatment; do not recommend repeated follow-up serum CA-125 (or other currently available biomarkers) measurements in women successfully using medical treatments for uncomplicated endometriosis in the absence of suspicious ovarian cysts; do not leave women undergoing surgery for ovarian endometriomas and not seeking immediate conception without post-operative long-term treatment with estrogen-progestins or progestins; do not perform laparoscopy in adolescent women (<20 years) with moderate-severe dysmenorrhea and clinically suspected early endometriosis without prior attempting to relieve symptoms with estrogen-progestins or progestins; do not prescribe drugs that cannot be used for prolonged periods of time because of safety or cost issues as first-line medical treatment, unless estrogen-progestins or progestins have been proven ineffective, not tolerated, or contraindicated; do not use robotic-assisted laparoscopic surgery for endometriosis outside research settings. Our proposal is to better address medical and surgical approaches to endometriosis de-implementing low-value interventions, with the aim to prevent unnecessary morbidity, limit psychological distress, and reduce the burden of treatment avoiding medical overuse and allowing a more equitable distribution of healthcare resources. |
| File Format | PDF HTM / HTML |
| DOI | 10.1093/hropen/hoz009 |
| Alternate Webpage(s) | https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9f/07/hoz009.PMC6560357.pdf |
| PubMed reference number | 31206037 |
| Alternate Webpage(s) | https://doi.org/10.1093/hropen%2Fhoz009 |
| Journal | Medline |
| Volume Number | 2019 |
| Journal | Human reproduction open |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
