A randomised trial comparing the H Pipelle with the standard Pipelle for endometrial sampling at ‘no‐touch’ (vaginoscopic) hysteroscopy

Abstract

Objectives To evaluate the effectiveness and tolerance of H Pipelle compared with the standard Pipelle as an endometrial biopsy device at outpatient ‘no‐touch’ hysteroscopy. Design A prospective randomised trial carried out in an outpatient diagnostic hysteroscopy clinic. Setting A large undergraduate teaching hospital. Population Sixty women investigated for abnormal menstruation in an outpatient diagnostic hysteroscopy clinic. Methods Prospective randomised trial comparing the H Pipelle with the standard Pipelle de Cornier. Main outcome measures Adequacy of the biopsy specimens and women’s experience. Results Ninety‐three percent (H Pipelle) and 87% (Pipelle) of the biopsy specimens were judged to be adequate for histological diagnosis (P > 0.05). However, obtaining endometrial sampling with the H Pipelle was significantly quicker (median times: 39 seconds [H Pipelle] and 102 seconds [Pipelle], P < 0.0001) and less painful (median visual analogue scale score: 1 [H Pipelle] and 5 [Pipelle], P = 0.011). Conclusions The H Pipelle not only makes it possible to perform hysteroscopy and endometrial biopsy with minimal instrumentation but is also associated with a shorter biopsy time and less discomfort than the standard Pipelle without any loss of biopsy adequacy.

Ambulatory hysteroscopy

“…Box 1 summarises the key recommendations for best practice in outpatient hysteroscopy and Box 2 summarises the key points of 'no touch' vaginoscopic hysteroscopy which should be the default technique in an outpatient environment. [2][3][4] Box 1. Summary of recommendations for best practice in outpatient hysteroscopy 1.…”

“…Directed biopsies can be taken using a biopsy cup via the operating channel of a rigid hysteroscope, or an H Pipelle can be used to take a global biopsy through the hysteroscopic sheath. 2,3 Tips to help identify the cervix vaginoscopically Mucus, blood or coil threads training from the cervical os can be followed to locate the cervix. A 30°angled hysteroscope makes it easier to identify the cervix.…”

Vaginoscopic approach to outpatient hysteroscopy: a systematic review of the effect on pain

“…In 2004, we described a device which allows endometrial sampling to be performed at diagnostic hysteroscopy without additional instrumentation by the simple step of withdrawing the optic from the diagnostic sheath whilst it is still in the uterine cavity, and inserting a lengthened Pipelle sampler, the H Pipelle (‘H’ stands for hysteroscopy), into the uterus to obtain the biopsy 3 . We have further shown that the use of the H Pipelle is associated with a shorter biopsy time and less patient discomfort than if a Pipelle is used following insertion of a vaginal speculum and tenaculum 4 …”

Ambulatory hysteroscopy and its role in the management of abnormal uterine bleeding

“…This is a 3.1 mm diameter suction biopsy cannula based on the well-established Pipelle that can be inserted through the inner sheath of a suitable hysteroscope once the telescope has been removed. This avoids the need to traverse the cervical canal blindly after hysteroscopy, which can be a problem in a minority of cases 46. Endometrial hyperplasia is often found within polyps, so complete hysteroscopic removal of polyps is recommended for diagnosis and treatment, followed by progestogenic therapy and OPH endometrial surveillance as appropriate 8…”