Early Diagnosis of Endometriosis

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Dr. James Carter: “We’re here at the International Society of Gynecologic Endoscopy, and I’m interviewing Dr. Ivo Brosens on some of their work at Catholic University in Leuven on the early diagnosis of endometriosis. Dr. Brosens, could you make some comments on that?”

Dr. Ivo Brosens: “Yes, I think that these days the problem that we see for the diagnosis of endometriosis is that there is a long delay in the diagnosis. In other words, people have symptoms and before the diagnosis of endometriosis is made, it takes between almost 3 ½ to 7 years. So that would be one of the diseases which has the longest interval between symptoms and diagnosis. The basic problem, I think, in this situation is that in fact where laparoscopy is a very useful tool for the sake of diagnosis, laparoscopy is basically expensive and invasive. And you could say it’s too expensive and too invasive for a diagnostic tool. In fact, in fifty years, laparoscopy has now become the gold standard for diagnosis, and the technique has not changed. 

Now what we have been concerned with is two things. First, we think that the distension medium in laparoscopy creates a number of artifacts if we want to see very delicate systems like fimbria or if we want to see subtle lesions like subtle lesions of endometriosis. We found that when we were looking into the fallopian tube, we need to look in the fallopian tube in an underwater system so that you can see the folds and cilia and so that things are not being masked. My colleague, Stephen Gross, then got the idea why shouldn’t we go back to the culdoscopic approach and from the combination of these two - culdoscopic approach and underwater exploration, I think offers the possibility of exploring the tubes and ovarian structures in their natural position. Without any manipulation we see the tubal structures very clearly and explore them for adhesions. This system can be applied in the office under local anesthesia. It also offers the patient an opportunity to better understand endometriosis. When you make an early diagnosis of endometriosis, she’s not going to be scared by the stories of dreadful endometriosis. Then the patient is also able to accept sometimes to wait and see and have a second procedure in six months or one year later to understand in this particular patient the evolution of the endometriosis, because many patients with endometriosis are very concerned. Then in the whole system of diagnosing, the decision to operate or not to operate certified over a period of time. I think that laparoscopy is an excellent tool for surgery. The case of the diagnosis and the case of the decision to operate or not to operate should be separated from the surgery itself. I think this will be to the benefit of the patient. In Europe, we have called this technique which we have called “transvaginal hydrolaparoscopy.”

Dr. James Carter: “Thank you very much, Dr. Brosens.”