Conservative treatment of deep infiltrating endometriosis: review of existing options

Abstract

Endometriosis with its estimated incidence rate of ∼7–10% of women of reproductive age is a disease with the wide spectrum of symptoms depending on form and localization of endometrial foci. One clinical form of endometriosis is deep infiltrating endometriosis (DIE), most difficult to manage and generating a lot of direct and indirect treatment costs. We search the literature from PubMed database to establish the role of conservative treatment of DIE. Randomised controlled trials are lacking but in experts opinion hormonal treatment should be the first-line treatment in DIE. After evaluation of pain or other symptoms, second-line therapy with GnRH analogs or danazol should be offered or minimally invasive surgery. Consensus is not made whether surgery is the best therapeutic treatment for affected patients. Strong depending on surgeon’s experience conservative surgery should be offered if the total excision of DIE foci is possible, which is essential for a successful outcome. If available treatment options do not release pain associated with DIE, experimental treatment in clinical trials should be discussed with patients.

Chinese abstract

子宫内膜异位症约发生于7%-10%的育龄妇女, 可表现为多种临床症状, 取决于子宫内膜异位病灶的形式和定位。子宫内膜异位症的一种临床表现形式为深部浸润性子宫内膜异位症, 最难以治疗, 并产生大量直接及间接治疗费用。我们从PubMed数据库检索文献, 并研究DIE保守治疗的作用。虽然缺乏随机对照试验, 但专家共识认为激素应作为DIE的一线治疗。在评估疼痛及其他临床症状后, 应提供如GnRH类似物或达那唑的二线治疗或微创手术。对于DIE患者而言手术是否是最好的治疗手段尚未达成共识。如果DIE病灶可被彻底切除–这是手术成功的关键, 应进行保守手术, 手术与外科医生的经验密切相关。如果可选择的治疗并不能缓解与DIE相关的疼痛, 应和患者讨论临床研究中的实验性治疗。

Keywords:

• Deep infiltrating endometriosis (DIE)
• laparoscopy
• progestins
• danazol

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by grant for young scientists founded by Polish Ministry of Science, Medical University of Lodz.