Comparison of the Efficacy and Safety of Ultrasound-Guided Sclerotherapy versus Cystectomy for the Treatment of Ovarian Endometriomas: A Systematic Review and Meta-Analysis

Abstract

Background: Ultrasound-guided sclerosis has been used to treat ovarian endometriotic cysts since 1988. However, compared with cystectomy, sclerotherapy's effectiveness and safety are questionable. Objective: To compare ultrasound-guided sclerotherapy and ovarian cystectomy in the treatment of ovarian endometriosis through a systematic review and meta-analysis. Methods: PubMed-MEDLINE, EMBASE, Cochrane, and Scopus databases were searched, and related literature was collected. The two treatments' recurrence rate, pain relief rate, pregnancy rate, technical success rate, and complication rate were directly compared. Results: Six studies (386 patients) were included. The risk of recurrence with sclerotherapy was higher than that with cystectomy (OR 1.57, p = 0.52). Subgroup analysis showed that an indwelling time > 10 min was not significantly different regarding recurrence risk between sclerotherapy and cystectomy (OR 1.01, p = 0.99). When the indwelling time was ≤ 10 min, the risk of recurrence with sclerotherapy was significantly higher than that with cystectomy (OR 22.01, p = 0.001). The pregnancy rate after cystectomy was lower than that after sclerosis (OR 1.67, p = 0.22). Complications in the study were graded according to the Clavien‒Dindo classification and statistical analysis showed that the probability of serious complications (Grade III-V) with cystectomy was higher than that with sclerosis (16.67% vs. 0%). Conclusion: Ultrasound-guided sclerotherapy was not inferior to cystectomy in terms of recurrence rate or pregnancy rate, and the incidence of severe complications was lower than that in the cystectomy group. Sclerotherapy is a safe and effective alternative treatment for ovarian endometriosis.