The clinical relevance of hysteroscopic polypectomy in premenopausal women with abnormal uterine bleeding

Dongen, Heleen van; Janssen, Catharina A.H.; Smeets, M. J. G. H.; Emanuel, Mark Hans; Jansen, Frank Willem

doi:10.1111/j.1471-0528.2009.02145.x

Cited by 29 publications

(24 citation statements)

References 24 publications

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“…Polyps occur in all age groups, but are most commonly found in women aged 40-49 years [5]. Their prevalence ranges are from 20 % in symptomatic premenopausal women to 40 % in the postmenopausal period [6,7].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors Associated with the Malignant Changes of Symptomatic and Asymptomatic Endometrial Polyps in Premenopausal Women

Elfayomy

Soliman

2014

J Obstet Gynecol India

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Objective This study aimed to evaluate the prevalence of premalignant and malignant lesions of symptomatic and asymptomatic endometrial polyps among premenopausal women and to verify whether different clinical parameters, and polyp volume and number are associated with a more precise estimate of malignancy. Methods One hundred and fifty women aged 29-52 years and with certain diagnosis of endometrial polyp were enrolled in a prospective observational study. The recruited patients underwent hysteroscopic polypectomy based on saline infusion sonohysterography and diagnostic hysteroscopy. Pathologic report was the main outcome. Results Among women with endometrial polyps, 62 % had asymptomatic polyps. The prevalence of premalignant and malignant polyps comprised 4.6 % of cases (3.3 % hyperplasia with atypia and 1.3 % carcinomatous polyps). The presence of abnormal uterine bleeding was not a predictor of premalignant and malignant changes in the polyp. On logistic regression analysis, the premalignant and malignant lesions were influenced by polycystic ovary syndrome (p \ 0.001; OR 4.61; CI 1.9-27), polyp volume [10 ml (p \ 0.001; OR 5.83; CI 4.31-9.17), and multiple polyps (p = 0. 01; OR 2.05; CI 1.09-3.76). Notably, the odds ratio of polyp volume [10 ml was 5.83. This additional risk confirms the importance of polyp volume in the detection of malignant transformation rather than associating bleeding in premenopausal women. Conclusion Polycystic ovary syndrome, polyp volume greater than 10 ml, and increased polyp number represent the markers of risk for premalignant and malignant 123 transformation of endometrial polyps in premenopausal women. Nonetheless, the majority of polyps are asymptomatic, and the risk of malignancy is very low. Therefore, for women with polyp volume B10 ml and no risk factors, a more expectant approach may be warranted in order to reduce surgical risks and costs.

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Section: Introductionmentioning

confidence: 99%

Risk Factors Associated with the Malignant Changes of Symptomatic and Asymptomatic Endometrial Polyps in Premenopausal Women

Elfayomy

Soliman

2014

J Obstet Gynecol India

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“…21 However, compared with saline infusion sonography (SIS), through which fluid is instilled to expand the uterine lumen and delineate the walls of the uterine cavity, or outpatient hysteroscopy (OPH), which directly visualises the inside of the uterus, TVS has poorer accuracy for diagnosing uterine polyps. 22,23 This is primarily because the sonographic findings are not specific to polyps, and other endometrial abnormalities -such as submucosal fibroids or endometrial irregularity -may have the same features, with the findings often subtle and easily overlooked especially for smaller polyps. 24 The development of ancillary technologies such as three-dimensional imaging and the use of colour or power Doppler may in time help improve the diagnostic accuracy of TVS for detecting focal pathologies within the uterus but evidence to date is lacking.…”

Section: Diagnosis Of Uterine Polypsmentioning

confidence: 99%

“…The 17 studies 23,75,91,97,101,[105][106][107][108][109][110][111][112][113][114] (including TJ Clark, Birmingham Women's Hospital, 2013, unpublished) that met our inclusion criteria enrolled a total of 1829 patients between 1989 and 2009. The population size ranged from 8 to 311, with only five studies having a population size of > 100.…”

Section: Included Studiesmentioning

confidence: 99%

A randomised controlled trial of Outpatient versus inpatient Polyp Treatment (OPT) for abnormal uterine bleeding

Clark

Middleton

Cooper

et al. 2015

Health Technol Assess

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BackgroundUterine polyps cause abnormal bleeding in women and conventional practice is to remove them in hospital under general anaesthetic. Advances in technology make it possible to perform polypectomy in an outpatient setting, yet evidence of effectiveness is limited.ObjectivesTo test the hypothesis that in women with abnormal uterine bleeding (AUB) associated with benign uterine polyp(s), outpatient polyp treatment achieved as good, or no more than 25% worse, alleviation of bleeding symptoms at 6 months compared with standard inpatient treatment. The hypothesis that response to uterine polyp treatment differed according to the pattern of AUB, menopausal status and longer-term follow-up was tested. The cost-effectiveness and acceptability of outpatient polypectomy was examined.DesignA multicentre, non-inferiority, randomised controlled trial, incorporating a cost-effectiveness analysis and supplemented by a parallel patient preference study. Patient acceptability was evaluated by interview in a qualitative study.SettingOutpatient hysteroscopy clinics and inpatient gynaecology departments within UK NHS hospitals.ParticipantsWomen with AUB – defined as heavy menstrual bleeding (formerly known as menorrhagia) (HMB), intermenstrual bleeding or postmenopausal bleeding – and hysteroscopically diagnosed uterine polyps.InterventionsWe randomly assigned 507 women, using a minimisation algorithm, to outpatient polypectomy compared with conventional inpatient polypectomy as a day case in hospital under general anaesthesia.Main outcome measuresThe primary outcome was successful treatment at 6 months, determined by the woman’s assessment of her bleeding. Secondary outcomes included quality of life, procedure feasibility, acceptability and cost per quality-adjusted life-year (QALY) gained.ResultsAt 6 months, 73% (166/228) of women who underwent outpatient polypectomy were successfully treated compared with 80% (168/211) following inpatient polypectomy [relative risk (RR) 0.91, 95% confidence interval (CI) 0.82 to 1.02]. The lower end of the CIs showed that outpatient polypectomy was at most 18% worse, in relative terms, than inpatient treatment, within the 25% margin of non-inferiority set at the outset of the study. By 1 and 2 years the corresponding proportions were similar producing RRs close to unity. There was no evidence that the treatment effect differed according to any of the predefined subgroups when treatments by variable interaction parameters were examined. Failure to completely remove polyps was higher (19% vs. 7%; RR 2.5, 95% CI 1.5 to 4.1) with outpatient polypectomy. Procedure acceptability was reduced with outpatient compared with inpatient polyp treatment (83% vs. 92%; RR 0.90, 95% CI 0.84 to 0.97). There were no significant differences in quality of life. The incremental cost-effectiveness ratios at 6 and 12 months for inpatient treatment were £1,099,167 and £668,800 per additional QALY, respectively.ConclusionsWhen treating women with AUB associated with uterine polyps, outpatient polypectomy was non-inferior to inpatient polypectomy at 6 and 12 months, and relatively cost-effective. However, patients need to be aware that failure to remove a polyp is more likely with outpatient polypectomy and procedure acceptability lower.Trial registrationCurrent Controlled Trials ISRCTN 65868569.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 61. See the NIHR Journals Library website for further project information.

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“…As it can be seen, the results obtained from our study are in accordance with the results obtained from similar studies. Van Dongen et al (2009) in a study carried out on 21 patients with abnormal uterine bleeding used hysteroscopy as a diagnostic or therapeutic method. The underlying reason was uterine polyp in most of the cases which was treated properly (Van Dongen et al, 2009).…”

Section: Abnormal Uterine Bleedingmentioning

confidence: 99%

“…Van Dongen et al (2009) in a study carried out on 21 patients with abnormal uterine bleeding used hysteroscopy as a diagnostic or therapeutic method. The underlying reason was uterine polyp in most of the cases which was treated properly (Van Dongen et al, 2009). Fuentes et al (2007) in a study carried out on 5103 cases of hysteroscopy due to abnormal uterine bleeding diagnosed and treated 641 cases of endometrial polyps.…”

Section: Abnormal Uterine Bleedingmentioning

confidence: 99%

Diagnostic Features and Therapeutic Consequences of Hysteroscopy in Women with Abnormal Uterine Bleeding and Abortion

J.¹

2012

American Journal of Applied Sciences

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Problem statement: Hysteroscopy is a procedure in which the endometrial cavity is observable and subject of manipulation via transcervical route. Hysteroscopy is a minimally invasive process in diagnosis and treatment of many intrauterine and endocervical conditions. Polypectomy, myomectomy and endometrial ablation could be easily manageable by this procedure. According to safety and high efficiency of hysteroscopy, this method is changing to a widespread procedure in dealing with many gynecologic and obstetrical conditions. This study aimed at evaluating the diagnostic and therapeutical efficiency of hysteroscopy in managing of common conditions including abnormal uterine bleeding and abortion. Approach: In a descriptive cross-sectional setting, 243 women underwent hysteroscopy were evaluated in two groups: with uterine bleeding 236 cases and with recurrent abortions 7 cases. This study was conducted in Tabriz Alzahra Educational Center during a 15-month period. The main causes of the complaints were determined in each group. Six months after treatment, the overall success rate was recorded. Results: Hysteroscopy was the sole diagnostic procedure in 16.5 and 14.3% of the patients in groups with abnormal uterine bleeding and abortion, respectively. In the group with abnormal uterine bleeding, curettage, myomectomy, polypectomy, hysterectomy, laparoscopy and laparotomy were the main diagnostic-therapeutical approaches along with the hysteroscopy in descending order. In the group with recurrent abortion, laparoscopy, curettage and myomectomy were the main diagnostic-therapeutical approaches along with the hysteroscopy in descending. There was not any major complication. The diagnostic-therapeutical measures accompanying with the laparoscopy were successful in 73.5% of the bleeding group in follow-up period. Conclusion: Based on our results, hysteroscopy is a safe, accurate and highly-efficient procedure in managing women with abnormal uterine bleeding and recurrent abortion.

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The clinical relevance of hysteroscopic polypectomy in premenopausal women with abnormal uterine bleeding

Cited by 29 publications

References 24 publications

Risk Factors Associated with the Malignant Changes of Symptomatic and Asymptomatic Endometrial Polyps in Premenopausal Women

Risk Factors Associated with the Malignant Changes of Symptomatic and Asymptomatic Endometrial Polyps in Premenopausal Women

A randomised controlled trial of Outpatient versus inpatient Polyp Treatment (OPT) for abnormal uterine bleeding

Diagnostic Features and Therapeutic Consequences of Hysteroscopy in Women with Abnormal Uterine Bleeding and Abortion

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