Effectiveness and complication rates of high intensity focused ultrasound treatment for abdominal wall endometriosis: A systematic review

• Published in: European journal of obstetrics & gynecology and reproductive biology 2024-06, Vol.297, p.15-23
• Main Authors: Knorren, Elisabeth R., de Ridder, Larissa A., Nijholt, Ingrid M., Dijkstra, Jeroen R., Braat, Manon N.G.J.A., Huirne, Judith A.F., Boomsma, Martijn F., Schutte, Joke M.
• Format: Article
• Language: English
• Subjects: Abdominal Wall - surgery; Abdominal wall endometriosis; Endometriosis - surgery; Endometriosis - therapy; Female; Focused ultrasound surgery; High intensity focused ultrasound; High-Intensity Focused Ultrasound Ablation - adverse effects; High-Intensity Focused Ultrasound Ablation - methods; Humans; Systematic review; Treatment Outcome; Ultrasonography, Interventional
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2024.03.029

•High intensity focused ultrasound (HIFU) is an effective and safe treatment option for abdominal wall endometriosis.•Pain score and lesion size reduction is accomplished without major complications and with a pooled recurrence rate of 12.8%.•There were no significant differences in pain scores, complications and recurrences after surgical excision and USgHIFU.•High-quality randomized controlled trials comparing HIFU to standard care are needed to provide more conclusive evidence. In this review, a systematic literature search on the effectiveness and complication rates of ultrasound-guided and magnetic resonance-guided high-intensity focused ultrasound (USg-/MRgHIFU) for abdominal wall endometriosis (AWE) was conducted in six databases in May/June 2023. Original articles of (non)randomized trials, cohort studies, case-control studies and case series published in peer-reviewed journals were included. Of the included studies the level of evidence (LoE) and methodological quality using the ROBINS-I and IHE-QAT was assessed. Primary outcomes were non-perfused volume ratio (NPV%), lesion size, pain scores, side effects and complication rates according to Society of Interventional Radiology (SIR) guidelines. Secondary outcomes were recurrence and re-intervention rates. Seven cohort studies (one of good methodological quality) (LoE 3) on USgHIFU were included (n = 212, AWE lesions = 240–245). Six months after USgHIFU treatment, pain scores were reduced with 3.3–5.2 points (baseline: 5.1–6.8, n = 135). Self-limiting side effects were pain (85.7 % (114/133)) and swelling (34.6 % (46/133)) in the treatment area. Complications occurred in 17.7 % (32/181), all of which were minor. Recurrence occurred in 12.8 % (11/86). Three of these seven cohort studies compared USgHIFU (n = 61) with surgical excision (n = 74). Pooled results showed no significant differences in pain scores, complications (resp. 26.3 % (10/38) vs. 32.6 % (15/46) (p = 0.53)) and recurrences (resp. 4.9 % (3/61) vs. 5.4 % (4/74) (p = 0.90)). This systematic review suggests that HIFU is an effective and safe treatment option for AWE. USgHIFU treatment led to reduced pain scores and lesion size, was free of major complications and had a pooled recurrence rate of 12.8 %. Compared to surgical excision pooled results showed no significant differences in pain scores, complications and recurrences after USgHIFU. However, many of the included studies had limitations in their methodological quality and therefor