Cosyns Stefan, Dony Noëlie, Tournaye Herman, Polyzos Nikolaos P
Department of Gynecology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZBrussel), Brussels, Belgium.
Department of Fertility, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZBrussel), Brussels, Belgium.
J Obstet Gynaecol. 2022 Oct;42(7):2888-2892. doi: 10.1080/01443615.2022.2111516. Epub 2022 Aug 26.
Ulipristal acetate (UPA), used for the treatment in women with symptomatic fibroids, is associated with endometrial changes visualised on ultrasound as thickening up to more than 16 mm in approximately 10% of the patients. Is saline infusion sonography (SIS) a good alternative for more invasive techniques, to evaluate the presence of intrauterine pathology? Ten patients, presenting with UPA associated endometrial changes at their follow up ultra-sonographic evaluation, were included. Our study demonstrated that SIS is feasible and painless in patients presenting with UPA associated endometrial changes. The thickened endometrium appears to divide at the midline, making it possible to study both layers separately and exclude any suspected intrauterine pathology. Our findings suggest that SIS may be a first choice, non-invasive, painless technique to provide a proper visualisation to rule out intrauterine pathology when UPA associated endometrial changes are diagnosed after fibroid treatment. This is especially of clinical interest in front of assisted reproductive technology treatment. Invasive techniques can be withheld for patients in whom SIS examination is not contributive.Impact Statement Reversible endometrial changes after ulipristal acetate (UPA) treatment in patients with symptomatic fibroids have been described. In patients who receive UPA, especially if planned to undergo ART, assessment of potential endometrial pathology is important as such interfere with proper implantation after ART. Consequently, clinicians may consider ruling out intrauterine pathology by invasive examinations such as biopsy or hysteroscopy after visualisation of the thickened endometrium. Saline infusion sonography (SIS) was feasible and painless in patients presenting with UPA associated endometrial changes. SIS may be a first choice, non-invasive, painless technique to provide a proper visualisation to rule out intrauterine pathology when UPA associated endometrial changes are diagnosed after fibroid treatment. This is especially of clinical interest in front of assisted reproductive technology treatment. Invasive techniques can be withheld for patients in whom SIS examination is not contributive in excluding intrauterine pathology.
醋酸乌利司他（UPA）用于治疗有症状的子宫肌瘤女性，约10%的患者经超声检查会出现子宫内膜变化，表现为增厚超过16毫米。盐水灌注超声检查（SIS）对于评估子宫内病变的存在，是否是一种比侵入性更强的技术更好的替代方法呢？纳入了10名在超声随访评估中出现与UPA相关的子宫内膜变化的患者。我们的研究表明，SIS对于出现与UPA相关的子宫内膜变化的患者是可行且无痛的。增厚的子宫内膜似乎在中线处分开，使得可以分别研究两层并排除任何可疑的子宫内病变。我们的研究结果表明，当子宫肌瘤治疗后诊断出与UPA相关的子宫内膜变化时，SIS可能是一种首选的、非侵入性、无痛的技术，用于提供适当的可视化以排除子宫内病变。这在辅助生殖技术治疗方面尤其具有临床意义。对于SIS检查无诊断价值的患者，可以不采用侵入性技术。
已描述了有症状的子宫肌瘤患者在接受醋酸乌利司他（UPA）治疗后出现的可逆性子宫内膜变化。在接受UPA治疗的患者中，尤其是计划接受辅助生殖技术（ART）的患者，评估潜在的子宫内膜病变很重要，因为这会干扰ART后的正常着床。因此，临床医生可能会考虑在可视化增厚的子宫内膜后，通过活检或宫腔镜检查等侵入性检查来排除子宫内病变。盐水灌注超声检查（SIS）对于出现与UPA相关的子宫内膜变化的患者是可行且无痛的。当子宫肌瘤治疗后诊断出与UPA相关的子宫内膜变化时，SIS可能是一种首选的、非侵入性、无痛的技术，用于提供适当的可视化以排除子宫内病变。这在辅助生殖技术治疗方面尤其具有临床意义。对于SIS检查在排除子宫内病变方面无诊断价值的患者，可以不采用侵入性技术。
