Novel technique to treat endometrial cysts is safe and effective

August 28, 2018

OAK BROOK, Ill. - A technique called catheter-based sclerotherapy is a safe and effective treatment for endometrial cysts and could help preserve fertility in patients, according to a study appearing in the journal Radiology.

Endometriosis occurs when the lining of the uterus, known as the endometrium, grows outside of the uterus and into surrounding tissues and organs. It is a common condition that affects about 10 percent of women of reproductive age. When endometriosis involves the ovaries, fluid-filled cysts called endometriomas may form, causing pelvic pain and abnormal uterine bleeding.

Surgery is a common treatment for endometriomas, but it carries risks, including the removal of healthy ovarian tissue, which can affect fertility. Needle-based sclerotherapy is a less-invasive option that involves inserting a needle into the cyst under ultrasound guidance and then withdrawing the cystic fluid through a needle. The cyst is then washed with a solution of ethanol. However, the needle-directed approach has limitations, said study co-author Man-Deuk Kim, M.D., Ph.D., professor at Severance Hospital, Yonsei University College of Medicine in Seoul, South Korea.

"Endometrial cyst content can be incredibly thick and sticky. A 16- or 18-gauge needle, which is commonly used for needle-directed sclerotherapy, is sometimes not large enough to completely evacuate the cyst," he said. "This may reduce the efficacy of sclerotherapy and increase the possibility of needle displacement during aspiration."

Dr. Kim and colleagues studied a sclerotherapy technique that replaces the needle with a catheter, a flexible tube used for removing fluid from cavities in the body. Along with draining cystic fluid more easily, a catheter allows for positional changes during the procedure, which helps maximize the ethanol's effectiveness by enabling it to contact the cyst wall evenly. The catheter also reduces the risk of spillage into the peritoneal cavity of the abdomen.

The researchers evaluated catheter-directed sclerotherapy with 95 percent ethanol in 14 women between the ages of 20 and 44 with ovarian endometriomas.

After about one year, the cysts had decreased on average from 5.8 centimeters (cm) in diameter to 1.1 cm. Pain was relieved in all patients, and blood tests indicated well-preserved ovarian function. There were no procedure-related complications.

There were no endometrioma recurrences, even in patients with internal septation, or division, within their cysts. The multiple compartments of septated cysts can be difficult to puncture with a needle, which may lead to incomplete sclerotherapy. In catheter-directed sclerotherapy, once the endometrioma is punctured, clinicians can manipulate the guidewire and catheter to break down internal septations, allowing for more effective treatment.

"In our study, the recurrence rate of catheter-directed sclerotherapy was 0 percent, which is very encouraging given that endometriomas measuring up to 13.5 centimeters in diameter or those that had internal septation were included in the study," Dr. Kim said.

The results suggest that catheter-based sclerotherapy could lead to better short-term clinical outcomes in women with endometrial cysts while preserving ovarian function and improving future fertility, Dr. Kim noted.

The researchers plan to conduct a study to see how catheter-directed sclerotherapy compares with surgery in terms of fertility, cyst recurrence and improvements in clinical symptoms.

"I hope our catheter-directed sclerotherapy will help women avoid surgery while maintaining ovarian reserve and fertility," Dr. Kim said.
"Catheter-directed Sclerotherapy for Ovarian Endometrioma: Short-term Outcomes." Collaborating with Dr. Kim were Kichang Han, M.D., Seok Kyo Seo, M.D., Gyoung Min Kim, M.D., Joon Ho Kwon, M.D., Hee Joon Kim, M.D., Jong Yun Won, M.D., and Do Yun Lee, M.D.

Radiology is edited by David A. Bluemke, M.D., Ph.D., University of Wisconsin School of Medicine and Public Health, Madison, Wis., and owned and published by the Radiological Society of North America, Inc..

RSNA is an association of over 54,200 radiologists, radiation oncologists, medical physicists and related scientists promoting excellence in patient care and health care delivery through education, research and technologic innovation. The Society is based in Oak Brook, Ill. (

For patient-friendly information on women's imaging, visit

Radiological Society of North America

Related Fertility Articles from Brightsurf:

What are your chances of having a second IVF baby after fertility treatment for the first?
As the restrictions on fertility clinics start to be lifted and IVF treatment resumes, research published in Human Reproduction journal offers reassuring news to women who have had to delay their treatment for a second IVF baby because of the coronavirus.

Fertility preservation use among transgender adolescents
Transgender adolescents often seek hormonal intervention to achieve a body consistent with their gender identity and those interventions affect reproductive function.

A new way to assess male fertility
Current tests for male fertility include measuring the concentration and motility of spermatozoa.

Male fertility after chemotherapy: New questions raised
Professor Delb├Ęs, who specializes in reproductive toxicology, conducted a pilot study in collaboration with oncologists and fertility specialists from the McGill University Health Centre (MUHC) on a cohort of 13 patients, all survivors of pediatric leukemia and lymphoma.

Vaping may harm fertility in young women
E-cigarette usage may impair fertility and pregnancy outcomes, according to a mouse study published in the Journal of the Endocrine Society.

Are fertility apps useful?
Researchers at EPFL and Stanford have carried out an analysis of the largest datasets from fertility awareness apps.

Marijuana and fertility: Five things to know
For patients who smoke marijuana and their physicians, 'Five things to know about ... marijuana and fertility' provides useful information for people who may want to conceive.

How could a changing climate affect human fertility?
Human adaptation to climate change may include changes in fertility, according to a new study by an international group of researchers.

Migrants face a trade-off between status and fertility
Researchers from the universities of Helsinki, Turku and Missouri as well as the Family Federation of Finland present the first results from a new, extraordinarily comprehensive population-wide dataset that details the lives of over 160,000 World War II evacuees in terms of integration.

Phthalates may impair fertility in female mice
A phthalate found in many plastic and personal care products may decrease fertility in female mice, a new study found.

Read More: Fertility News and Fertility Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to