Collaboration Between the Surgical and Medical Experts of Endometriosis Needed

Where is the consensus for the treatment of endometriosis?

Key Points

Highlights:

Surgical and medical experts should collaborate to improve the consensus in the treatment and management of endometriosis.

Key Results:

• The treatment of endometriosis should include careful assessment of the potential benefits, potential harms, costs of the interventions and the patient’s preferences.
• Experts in both the surgical and medical treatment of endometriosis should collaborate to seek the most efficient way to improve patient care.
• A consensus on the treatment of the various forms of endometriosis should be sought after using firm and sound evidence gathered from evidence-based medicine such as randomized controlled trials.

What’s done here?

• This article aims to offer a perspective regarding the treatment of pelvic pain symptoms associated with endometriosis and the ongoing debate concerning what type of therapy can yield the best results.

Limitations:

• This article is an opinionated perspective.

Lay Summary

The authors of this perspective article aim to initiate a dialogue regarding the current evidence regarding the surgical and medical treatment of endometriosis. In their view, the quality of data regarding the outcomes of surgery for endometriosis is lacking and that more surgical randomized controlled trials are needed. When debating the role of medical and surgical treatment of endometriosis, care should be taken to use the consensus of a group of experts for consensus guidelines. This is compounded by the reality that profit from the healthcare system, manufacturers, and hospitals skew therapeutic indications toward surgery.

A comparison is made to highlight analogies between severe endometriosis and severe gastroesophageal reflux disease (GERD). In both cases, prevalence is high, both are chronic diseases, and both can be treated with surgical or medical means. The management of both of these diseases are also different, and the research supporting the surgical management of GERD and endometriosis differs. In the author’s opinion, not many large cohort studies and randomized controlled studies have been conducted on the effect of excisional surgery for deep endometriosis. Thus, they argue that the risk of bias is high when it comes to the surgical treatment of deep endometriosis and that overemphasis on the effect of the surgical intervention in endometriosis is possible.

The authors also point out that paternalistic medicine, the notion that the doctor knows best for the patient, maybe a significant contributor to the argument between surgical and medical experts regarding the treatment of endometriosis. It may also be why more attention is needed regarding the emphasis on the patient’s goals and preferences when deciding treatment options. This patient-centered approach to treating deep endometriosis is what the authors of the article aim to highlight for future dialogue.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/29031679