Efficacy of the revised Enzian classification: a retrospective analysis. Does the revised Enzian classification solve the problem of duplicate classification in rASRM and Enzian?

Haas, Dietmar; Wurm, Peter; Shamiyeh, Andreas; Shebl, Omar; Chvatal, Radek; Oppelt, Peter

doi:10.1007/s00404-012-2647-1

Cited by 41 publications

(36 citation statements)

References 13 publications

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“…Both classifications have their strong and weak points: on one hand the ASRM classification evaluates intraperitoneal abnormalities associated with A c c e p t e d M a n u s c r i p t 5 endometriosis but does not take into account the presence of DIE lesions, and on the other, the ENZIAN-score evaluates DIE lesions but does not consider intraperitoneal endometriotic locations. For these reasons, a new classification is justified taking into account both intraand subperitoneal endometriotic lesions [17].…”

Section: Introductionmentioning

confidence: 99%

Colorectal endometriosis and fertility

Daraı̈

Cohen

Ballester

2017

European Journal of Obstetrics & Gynecology and Reproductiv

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Objective: The goal of this review was to assess the impact of colorectal endometriosis on spontaneous fertility and the potential benefit of Medically Assisted Reproduction (MAR) (in vitro fertilization and intrauterine insemination) and surgery on fertility outcomes.Study design: MEDLINE search for articles on fertility in women with DIE published between 1990 and December 2015 using the following terms: "deep endometriosis", "deep infiltrating endometriosis", "bowel endometriosis", "colorectal endometriosis", "fertility", "infertility", "IVF-ICSI", "Assisted Reproductive Techniques (ART)", and "MAR".Results: Spontaneous pregnancy rate (PR) in patients undergoing resection of DIE but leaving in situ colorectal endometriosis was 26.5% (95% CI = 14-39). PR after MAR was 27.4% (95% CI = 19-35) and the overall PR was 37.9% (95% CI = 29-37). After colorectal surgery, among the 855 patients with and without proved infertility, the spontaneous PR was 31.4% (95% CI = 28-34) without difference between the groups. PR after MAR was 19.8% (95% CI = 17-22). PR after MAR in patients with and without proved infertility was 21.4% (95% CI = 18-25) and 15.5% (95% CI = 11-20), respectively. The overall PR after colorectal surgery was 51.1% (95% CI = 48-54). Conclusion:Our review supports a potential benefit of surgery on fertility outcomes for women with colorectal endometriosis. Further studies are required to determine whether surgical management should be first-intention or restricted to failure of MAR.

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Section: Introductionmentioning

confidence: 99%

Colorectal endometriosis and fertility

Daraı̈

Cohen

Ballester

2017

European Journal of Obstetrics & Gynecology and Reproductiv

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“…Furthermore, this method is useful for the description of not only histologically confirmed endometriosis but also of clinically suspected lesions. In contrast, although the rASRM score is currently the best known, most widely used and the reference classification for endometriosis, it does not take into account either the involvement of retroperitoneal structures in DIE or adenomyosis [12,13,18] . In our study, the rectovaginal septum and vagina (compartment A) were primarily affected, followed by the sacrouterine ligament to the pelvic wall (compartment B) and the rectum and sigmoid colon (compartment C).…”

Section: Discussionmentioning

confidence: 99%

“…We used the Enzian classification of endometriosis, which is considered the best rating tool for the morphological categorization of DIE lesions [18] . This classification method allows registering the extent to which the retroperitoneal structures are affected and takes adenomyosis into account.…”

Section: Discussionmentioning

confidence: 99%

Endometriotic Pain Is Associated with Adenomyosis but Not with the Compartments Affected by Deep Infiltrating Endometriosis

Perelló

Martínez-Zamora

Torres

et al. 2016

Gynecol Obstet Invest

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Background: The identification of presurgical clinical markers may be helpful to allow the staging of endometriosis severity. It has been suggested that pain characteristics orientate the gynecologist about the anatomical involvement of endometriosis. The study was performed to analyze the correlation between pain symptoms and the anatomical location of endometriosis. Methods: One hundred fifty-five consecutive patients with a complete removal of deep infiltrating endometriosis (DIE) were included. Prior to surgery, data on patient and disease characteristics were obtained. The intensity of the pain symptoms was registered using a Visual Analogue Scale. The endometriotic lesions were categorized according to the Enzian morphological classification. Correlation and multivariate analysis were performed to assess the potential associations between pain characteristics (dysmenorrhea, pelvic pain, dyschezia, dyspareunia or dysuria) and the location of endometriosis or other disease-related characteristics (hematuria, rectal bleeding or adenomyosis). Results: Pelvic pain was significantly associated with the presence of adenomyosis. Dyschezia was correlated with rectal bleeding and dysuria with the presence of hematuria. No relationship was found between other kinds of pain and the morphological location of endometriosis or other disease-related characteristics. Conclusion: Our data suggest that pelvic pain is correlated with the presence of adenomyosis in women with DIE. Further studies are required.

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“…The ENZIAN score is a helpful aid to describe DIE, but it needs to be modified . However, the revised ENZIAN classification is an excellent complement to the revised AFS score for the morphological classification of DIE .…”

Section: Laparoscopic Assessment For Staging Of Die: Which Scoring Symentioning

confidence: 99%

Laparoscopic surgery with urinary tract reconstruction and bowel endometriosis resection for deep infiltrating endometriosis

Ota

Andou

Ota

2018

Asian J Endoscop Surgery

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Deep infiltrating endometriosis (DIE) is the most severe form of endometriosis. It causes chronic pelvic pain, severe dysmenorrhea, deep dyspareunia, dyschezia, and dysuria, markedly impairing the quality of life of women of reproductive age. A number of randomized controlled trials on surgical and medical treatments to reduce the pain associated with endometriosis have been reported, but few have focused on this in DIE. DIE causes not only pain but also functional invasion to the urinary organs and bowel, such as hydronephrosis and bowel stenosis. In addition to DIE resection, surgical treatment involves adhesion separation as well as resection and reconstruction of the urinary organs and bowel; high-level skills are required. The severity of DIE should be evaluated preoperatively as accurately as possible. Using ENZIAN in conjunction with the AFS (The revised American Fertility Society classification of endometriosis) classification makes a more detailed assessment of DIE possible. The operative procedures used for laparoscopic resection of urinary DIE and reconstruction of the urinary organs are chosen based on the type of lesion (intrinsic/extrinsic) and length of stenosis. In addition to ureteroneocystostomy, the psoas bladder hitch and Boari bladder flap procedures are applied when necessary to extend the urinary tract. Bowel resection for bowel endometriosis is classified into classic segmental resection and conservative approaches (shaving/discoid). When these procedures are employed, it is advisable to work in consultation with urologists and gastroenterologists and to inform the patients of the associated risks and outcomes. Furthermore, postoperative medication is essential because it is difficult to conduct repeated surgeries.

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Efficacy of the revised Enzian classification: a retrospective analysis. Does the revised Enzian classification solve the problem of duplicate classification in rASRM and Enzian?

Abstract: The revised Enzian classification is an excellent complement to the rASRM score for morphological description of DIE.

Cited by 41 publications

References 13 publications

Colorectal endometriosis and fertility

Colorectal endometriosis and fertility

Endometriotic Pain Is Associated with Adenomyosis but Not with the Compartments Affected by Deep Infiltrating Endometriosis

Laparoscopic surgery with urinary tract reconstruction and bowel endometriosis resection for deep infiltrating endometriosis

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