The best method for the diagnosis of endometriosis: SEE and BELIEVE

Diagnostic laparoscopy has more advantages over other diagnostic methods, the study argues

Key Points

Highlight:

• Despite recent efforts to find a non-invasive diagnostic test, diagnostic laparoscopy still serves as a safe and reliable method in the diagnosis of endometriosis.

Importance:

• Diagnosing patients without further delay is important in providing them with good health care.
• When deciding on the best method for each patient, surgical and imaging modalities can be used together.

What is done here:

• This is a commentary article about the use of diagnostic laparoscopy in endometriosis diagnosis.
• Certain statements about the advantages of diagnostic laparoscopy were argued in detail.

Key results:

• Diagnostic laparoscopy is a safe procedure with very low mortality and complication rates.
• Identifying the pathology is very important for patient management.
• Diagnostic laparoscopy reduces diagnostic delay which is also beneficial for maintaining fertility in these patients.
• A negative laparoscopy is a valuable tool in the workup of patients that present with chronic pelvic pain.
• Diagnostic laparoscopy is still seen as the gold standard method in endometriosis diagnosis compared to other methods such as ultrasound and MRI, biomarkers, patient history, and patient response to medical treatments.
• Imaging and laparoscopy aid one another and should be used together.
• Empirical therapy should not be considered diagnostic
• Diagnostic laparoscopy is also helpful for infertile patients.

Lay Summary

Deciding on the best diagnostic procedure for endometriosis patients has been a recent subject of debate. While some clinicians believe non-invasive methods such as imaging and symptom-based treatment should be the choice in the diagnosis, some believe the best method to detect the lesion is by seeing it via diagnostic laparoscopy.

In the debate article written by Mak et al., it is argued that diagnostic laparoscopy is still a justified and useful diagnostic test in the diagnosis of endometriosis. The article was published as a commentary in the July 2022 issue of the journal Reproduction and Fertility. 

Firstly, it is stated that diagnostic laparoscopy is a safe procedure with very low mortality and complication rates. If only entry and examination are performed it is even safer than therapeutic laparoscopy. Secondly, identifying the pathology is very important for patient management which makes way for potential treatment and improvement in symptoms and quality of life of the patients. Another important feature of diagnostic laparoscopy is that it reduces diagnostic delay which is also beneficial for maintaining fertility in these patients. The authors define a negative laparoscopy as a valuable tool in the workup of patients that present with chronic pelvic pain. Proving that the patient does not have endometriosis may relieve them and makes it possible to look for other pathologies than endometriosis.

Diagnostic laparoscopy is still seen as the gold standard method in endometriosis diagnosis compared to other methods such as ultrasound and MRI, biomarkers, patient history, and patient response to medical treatments. It was argued that enhanced imaging methods have shown their value in the diagnosis of endometriosis however, most abnormalities are still not being detected pre-operatively. The authors accept that “Just as imaging should not replace laparoscopy, nor should laparoscopy replace imaging.” The pivotal role of imaging in pre-operative triage should not be overlooked. In some studies, transvaginal ultrasound was shown to be more effective than diagnostic laparoscopy in deep endometriosis. This highlights the potential for diagnostic laparoscopy and imaging to be used together. It is also stated that empirical therapy should not be considered diagnostic. Diagnostic laparoscopy is also helpful for infertile patients because it provides useful diagnostic information.

The authors conclude by saying that diagnostic laparoscopy is safe and irreplaceable and the benefits of a negative laparoscopy should not be undervalued as it is an important key step in patient management.

Research Source: https://pubmed.ncbi.nlm.nih.gov/35794928/