Efficacy of Uterine Artery Blockage in Endometriosis Management

Could it be a new clinical remedy for the management of endometriosis?

Key Points

Highlights:

• Although it seems that uterine artery blockage reduces menstrual pain and serum CA125 levels in endometriosis patients, due to the limitation of the quality of included articles, a larger sample size and high-quality research are necessary to provide stronger evidence for clinical practice.
  

Importance:

• Uterine artery blockage, i.e. embolization is a well-known procedure in the management of female surgical pelvic bleeding and gynecological diseases.
• It has several advantages such as being less traumatic with quick recovery, and preservation of the uterus as well as conforming to patient-oriented medical ethics.
• Recently, uterine artery embolizations in endometriosis patients representing minimally invasive therapy have been applied in a considerable number of patients.

What's done here:

• The authors have performed a computerized search published till June 2022  for controlled trials of uterine artery embolization besides other medical treatments in endometriosis.
• PubMed, Embase, Web of Science, Cochrane Library, China Journal Full-Text Database, Wanfang Database, VIP Database, and China Biomedical Literature Database were used.

Key Results:

• Out of 338 articles retrieved from the databases, 7 controlled trials were included.
• The literature search revealed that the serum CA125 level after uterine artery embolization was significantly lower than the control group, and the postoperative dysmenorrhea was significantly lower than the control group.

Limitations of the study:

• The included controlled trials have certain risks during the randomization, which may cause selectivity bias. 
• Not including relevant English papers, and only the Chinese publications that met the criteria were studied.
• The quality of the relevant publications is low, which yields a negative reliability effect on final outcomes.
• Another drawback that should be questioned in this database search is the possible impact of commonly used antimicrobials such as penicillin and ornidazole.

Lay Summary

Dr. Li Ma and associates from Liaoning, China have published their results of a computerized database search on the role of uterine artery embolization in endometriosis in a recent issue of the periodical “Computational Intelligence and Neuroscience”.

Currently, the management of endometriosis consists of surgical interventions add hormonal therapy. This classic approach may slow down the development of endometriosis, and achieve the purpose of relieving the disease and inhibiting recurrence.

Thinking that the application of uterine artery embolization in the management of female gynecological diseases with pelvic bleeding that necessitates surgery is quite successful, and it can be beneficial in endometriosis patients; a computerized database search for controlled trials of uterine artery embolization was performed using PubMed, Embase, Web of Science, Cochrane Library, China Journal Full-Text Database, Wanfang Database, VIP Database, and China Biomedical Literature Database.

The uterine artery embolization has several advantages such as being less traumatic with rapid postoperative recovery, uterine preservation, and patient-oriented medical ethics of minimally invasive modalities.

A total of 338 articles were retrieved from the database, 230 articles remained after preliminary screening, and finally, 7 controlled trials were analyzed.

There are some important limitations of these publications: All 7 controlled trials analyzed in this paper have certain risks during the randomization which may cause certain selectivity bias. English language papers were not included, and only the Chinese publications that met the criteria were studied. Besides the quality of the relevant publications is low, imposing a negative effect on the reliability of final outcomes.

The interpretation of the publications reveals that the serum CA125 level and the postoperative dysmenorrhea measurements by visual analog scale were significantly lower than the control group. 

The authors conclude that although uterine artery embolization seems to reduce dysmenorrhea and serum CA125 levels in endometriosis patients, the questionable quality of the included articles, the need for a larger sample size, and high-quality randomized controlled trials are in need of stronger evidence for clinical applications.

Research Source: https://pubmed.ncbi.nlm.nih.gov/36248948/