Cryoablation to Treat Abdominal Wall Endometriosis

Cryoablation may be a non-invasive treatment option for Abdominal Wall Endometriosis

Key Points

Highlights: 

• This article has presented three cases of abdominal wall endometriosis that were treated with cryoablation and explained the surgeons' experiences with patient outcomes and clinical management using this minimally invasive treatment modality.

Importance:

• Endometriosis of the abdominal wall (AWE) is often painful and requires hormone therapy or surgery for clinical management. Thus, non-invasive treatment options to help reduce pain and the progression of these lesions are needed.

Key Results:

• All three patients reported that their pain levels completely subsided after 6-12 weeks post-treatment.
• One patient experienced pain three weeks after treatment that required further pain management but the all were managed effectively post-treatment without the use of narcotics.
• For patients with AWE involving underlying musculature, longer post-treatment heal times and analgesic use should be expected.
• Cryoablation should be done by initial visualization, administration of local anesthesia, and probe placement by ultrasound to minimize complications.

Limitations 

• This is a report from only 3 patients and results can not be evaluated statistically due to small sample size.
• Long term outcome is not evaluated.

Lay Summary

Endometriosis of the abdominal wall (AWE) is often painful and requires hormone therapy or surgery for clinical management. Thus, non-invasive treatment options to help reduce pain and the progression of these lesions will help patients who suffer from this disease. This article presents researchers’ experiences using image-guided cryoablation to treat superficial abdominal wall endometriosis in 3 patients.

Three patients from the Rhode Island Hospital underwent ultrasound and CT-guided cryoablation from 2015 to 2016. Cryoablation is a procedure whereby a mass or lesion is frozen using a probe that injects a liquid or gas to cytotoxic temperatures. The treatment involved varying freeze cycle durations followed by a thaw cycle followed by another freeze cycle. Time for each cycle was determined based on the characteristics of the endometriotic lesion and surgical decision. During the operation, care was taken to protect the skin, abdominal wall, and underlying bowel from the treatment. Post-operation CT scans were performed to confirm treatment margins around the endometriotic lesions and pain levels were assessed and properly managed.

One out of three patients had biopsy-proven AWE of the underlying musculature before surgery but the other two were biopsied to confirm AWE during the procedure. One patient experienced pain three weeks after treatment that required further pain management. However, all were managed effectively post-treatment without the use of narcotics. Using a subjective pain score (1-10) questionnaire before and after treatment, all three patients reported that their pain levels completely subsided after 6-12 weeks post-treatment.

This study yields some insight on the feasibility of this treatment modality for women who suffer from abdominal wall endometriosis. However, the article notes that certain procedures should be followed if cryoablation is offered in a certain hospital or medical center. Firstly, cryoablation should be done by initial visualization, administration of local anesthesia, and probe placement by ultrasound. Additionally, care should be taken to avoid damaging adjacent structures and validated by post-surgical CT scan to allow for confirmation of treatment margins. These steps will ensure that radiation exposure and post-surgical complications are minimized.

While this study suggests favorable outcomes for AWE treated by cryoablation, the small sample size and lack of data on long-term outcomes of these patients need to be addressed in future clinical trials.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/28609130