Effectiveness of Hysteroscopic Techniques for Endometrial Polyp Removal: The Italian Multicenter Trial.
J Minim Invasive Gynecol
; 26(6): 1169-1176, 2019.
Article
em En
| MEDLINE
| ID: mdl-30528831
ABSTRACT
STUDY OBJECTIVE:
To compare the effectiveness and safety of different techniques of hysteroscopic polypectomy.DESIGN:
Multicenter, prospective observational trial (Canadian Task Force classification II-2).SETTING:
Nineteen Italian gynecologic departments (university-affiliated or public hospitals). PATIENTS Consecutive patients suffering from endometrial polyps (EPs).INTERVENTIONS:
Hysteroscopic polypectomy, as performed through different techniques. MEASUREMENTS AND MAINRESULTS:
Included in the study were 1404 patients (with 1825 EPs). The setting was an ambulatory care unit in 40.38% of the cases (567 women), of whom 97.7% (554) did not require analgesia/anesthesia. In the remaining 59.62% of women (837 women), the procedures were performed in an operating room under mild sedation, local or general anesthesia. Minor complications occurred in 32 patients (2.27%), without significant differences between the techniques used (pâ¯=â¯ns). Uterine perforation occurred in 14 cases, all performed in the operating room with some kind of anesthesia, only 1 with a vaginoscopic technique and the remaining during blind dilatation (odds ratio [OR], 19.98; 95% confidence interval [CI], 1.19-335.79; pâ¯=â¯.04). An incomplete removal of EPs was documented in 39 patients. Logistic regression analysis showed that a higher risk of residual EPs was associated with the use of a fiber-based 3.5-mm hysteroscope (OR, 6.78; 95% CI, 2.97-15.52; p <.001), the outpatient setting (OR, 2.17; 95% CI, 1.14-4.14; pâ¯=â¯.019), and EPs located at the tubal corner (OR, 1.98; 95% CI, 1.03-2.79; pâ¯=â¯.039). No association between incomplete EP removal and EP size or number was recorded (pâ¯=â¯ns), as well as with the other variables evaluated.CONCLUSION:
Outpatient polypectomy was associated with a minimal but significantly higher risk of residual EPs in comparison with inpatient polypectomy. Conversely, inpatient polypectomy was associated with a considerably higher risk of uterine perforation and penetration in comparison with office hysteroscopy. Because of lower intraoperative risks and higher cost-effectiveness, office hysteroscopy may be considered, whenever possible, as the gold standard technique for removing EPs.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Pólipos
/
Neoplasias Uterinas
/
Histeroscopia
Tipo de estudo:
Clinical_trials
/
Etiology_studies
/
Observational_studies
Limite:
Adult
/
Female
/
Humans
/
Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
J Minim Invasive Gynecol
Assunto da revista:
GINECOLOGIA
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
Itália