Department of Gynecology, Center for Endometriosis, Hospital St. John of God, Vienna, Austria.
Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria.
Hum Reprod. 2022 Sep 30;37(10):2359-2365. doi: 10.1093/humrep/deac187.
How is endometriosis extent described by the #Enzian classification compared to the revised American Society for Reproductive Medicine (rASRM) stages in women undergoing radical surgery for deep endometriosis (DE)?
The prevalence and severity grade of endometriotic lesions and adhesions as well as the total number of #Enzian compartments affected by DE increase on average with increasing rASRM stage; however, DE lesions are also present in rASRM stages 1 and 2, leading to an underestimation of disease severity when using the rASRM classification.
Endometriotic lesions can be accurately described regarding their localization and severity by sonography as well as during surgery using the recently updated #Enzian classification for endometriosis.
STUDY DESIGN, SIZE, DURATION: This was a prospective multicenter study including a total of 735 women between January 2020 and May 2021.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Disease extent in women undergoing radical surgery for DE at tertiary referral centers for endometriosis was intraoperatively described using the #Enzian and the rASRM classification.
A total of 735 women were included in the study. Out of 31 women with rASRM stage 1, which is defined as only minimal disease, 65% (i.e. 20 women) exhibited DE in #Enzian compartment B (uterosacral ligaments/parametria), 45% (14 women) exhibited DE in #Enzian compartment A (vagina/rectovaginal septum) and 26% (8 women) exhibited DE in #Enzian compartment C (rectum). On average, there was a progressive increase from rASRM stages 1-4 in the prevalence and severity grade of DE lesions (i.e. lesions in #Enzian compartments A, B, C, FB (urinary bladder), FU (ureters), FI (other intestinal locations), FO (other extragenital locations)), as well as of endometriotic lesions and adhesions in #Enzian compartments P (peritoneum), O (ovaries) and T (tubo-ovarian unit). In addition, the total number of #Enzian compartments affected by DE lesions on average progressively increased from rASRM stages 1-4, with a maximum of six affected compartments in rASRM stage 4 patients.
LIMITATIONS, REASONS FOR CAUTION: Interobserver variability may represent a possible limitation of this study.
The #Enzian classification includes the evaluation of DE in addition to the assessment of endometriotic lesions and adhesions of the ovaries and tubes and may therefore provide a comprehensive description of disease localization and extent in women with DE.
STUDY FUNDING/COMPETING INTEREST(S): No funding was received for this study. All authors declare that they have no conflict of interest.
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在接受根治性手术治疗深部子宫内膜异位症（DE）的女性中，#Enzian 分类描述的子宫内膜异位症严重程度与经修订的美国生殖医学学会（rASRM）分期相比如何？
随着 rASRM 分期的增加，DE 病变和粘连的发生率和严重程度等级以及受 DE 影响的#Enzian 分区总数平均增加；然而，rASRM 分期 1 和 2 也存在 DE 病变，因此使用 rASRM 分类会低估疾病严重程度。
通过超声以及最近更新的#Enzian 子宫内膜异位症分类在手术中，可以准确描述子宫内膜异位症病变的定位和严重程度。
研究设计、大小和持续时间：这是一项前瞻性多中心研究，共纳入 2020 年 1 月至 2021 年 5 月期间三级子宫内膜异位症转诊中心接受根治性手术的 735 名女性。
参与者/材料、地点和方法：在三级子宫内膜异位症转诊中心接受根治性手术的 DE 女性的疾病严重程度在手术中使用#Enzian 和 rASRM 分类进行描述。
共有 735 名女性纳入研究。在 31 名 rASRM 分期为 1 期（定义为仅有轻微疾病）的女性中，65%（即 20 名女性）在#Enzian 分区 B（子宫骶韧带/子宫旁组织）中存在 DE，45%（14 名女性）在#Enzian 分区 A（阴道/直肠阴道隔）中存在 DE，26%（8 名女性）在#Enzian 分区 C（直肠）中存在 DE。平均而言，从 rASRM 分期 1-4，DE 病变（即分区 A、B、C、FB（膀胱）、FU（输尿管）、FI（其他肠道部位）、FO（其他生殖部位）的发生率和严重程度等级逐渐增加）以及分区 P（腹膜）、O（卵巢）和 T（卵巢-输卵管单位）中的子宫内膜异位症病变和粘连的发生率逐渐增加。此外，从 rASRM 分期 1-4，受 DE 病变影响的#Enzian 分区总数逐渐增加，rASRM 分期 4 患者最多有六个分区受到影响。
局限性、谨慎的原因：观察者间的变异性可能是本研究的一个潜在限制。
#Enzian 分类除了评估卵巢和输卵管的子宫内膜异位症病变和粘连外，还包括 DE 的评估，因此可为 DE 女性的疾病定位和严重程度提供全面描述。
研究资金/利益冲突：本研究未收到任何资金。所有作者均声明不存在利益冲突。
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