The 10 “Cardinal Sins” in the Clinical Diagnosis and Treatment of Endometriosis: A Bayesian Approach

Author:

Koninckx Philippe R.12345ORCID,Ussia Anastasia6ORCID,Gordts Stephan7ORCID,Keckstein Jörg89ORCID,Saridogan Ertan10ORCID,Malzoni Mario11ORCID,Stepanian Assia12,Setubal Antonio13ORCID,Adamyan Leila1415ORCID,Wattiez Arnaud516ORCID

Affiliation:

1. Department of OBGYN, Faculty of Medicine, Katholieke University Leuven, 3000 Leuven, Belgium

2. Department of OBGYN, Faculty of Medicine, University of Oxford, Oxford OX1 2JD, UK

3. Department of OBGYN, Faculty of Medicine, University Cattolica, del Sacro Cuore, 00168 Rome, Italy

4. Department of OBGYN, Faculty of Medicine, Moscow State University, 119991 Moscow, Russia

5. Latifa Hospital, Dubai 9115, United Arab Emirates

6. Department of OBGYN, Gemelli Hospitals, Università Cattolica, 00168 Rome, Italy

7. Leuven Expert Center, 3000 Leuven, Belgium

8. Endometriosis Centre, Dres. Keckstein, 9500 Villach, Austria

9. Faculty of Medicine, University Ulm, 89081 Ulm, Germany

10. Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London SW7 2BX, UK

11. Malzoni Centre Avelino, 83100 Avellino, Italy

12. Academia of Women’s Health and Endoscopic Surgery, Atlanta, GA 30328, USA

13. Department of Ob/Gyn and MIGS, Hospital da Luz Lisbon, 1500-650 Lisboa, Portugal

14. Department of Operative Gynecology, Federal State Budget Institution V. I. Kulakov, Research Centre for Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, 117198 Moscow, Russia

15. Department of Reproductive Medicine and Surgery, Moscow State University of Medicine and Dentistry, 127473 Moscow, Russia

16. Department of Obstetrics and Gynaecology, University of Strasbourg, 67081 Strasbourg, France

Abstract

Evidence-based data for endometriosis management are limited. Experiments are excluded without adequate animal models. Data are limited to symptomatic women and occasional observations. Hormonal medical therapy cannot be blinded if recognised by the patient. Randomised controlled trials are not realistic for surgery, since endometriosis is a variable disease with low numbers. Each diagnosis and treatment is an experiment with an outcome, and experience is the means by which Bayesian updating, according to the past, takes place. If the experiences of many are similar, this holds more value than an opinion. The combined experience of a group of endometriosis surgeons was used to discuss problems in managing endometriosis. Considering endometriosis as several genetically/epigenetically different diseases is important for medical therapy. Imaging cannot exclude endometriosis, and diagnostic accuracy is limited for superficial lesions, deep lesions, and cystic corpora lutea. Surgery should not be avoided for emotional reasons. Shifting infertility treatment to IVF without considering fertility surgery is questionable. The concept of complete excision should be reconsidered. Surgeons should introduce quality control, and teaching should move to explain why this occurs. The perception of information has a personal bias. These are the major problems involved in managing endometriosis, as identified by the combined experience of the authors, who are endometriosis surgeons.

Publisher

MDPI AG

Subject

General Medicine

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