The #Enzian classification, an essential tool for surgical management of severe endometriosis

The #Enzian classification is a new and comprehensive non-invasive endometriosis classification system to provide communication between the clinicians and the patient.

Key Points

Highlights:

• This lecture entitled "The #Enzian classification, an essential tool for surgical management of severe endometriosis" was presented by Dr. Jörg Keckstein, Professor at University Ulm, Germany, at the Annual International Medical Conference of the Endometriosis Foundation of America held in New York on April 1-2, 2023.
• The #Enzian classification is a useful classification system in the management of patients with endometriosis as it provides a correlation between symptoms and the extent of the disease.

Importance:

• Endometriosis classification should be unified and should be used in an interdisciplinary manner in order to plan preoperative surgery and to determine treatment, and follow-up.

What’s done here?

• Dr. Keckstein explained the details, usability, and benefits of the new Enzoan classification, namely "#Enzian classification", comparing older endometriosis classification systems.

Outlines:

• Assessment of the state of endometriosis is possible using an accurate and comprehensive classification system with respect to its extent, location, and clinicopathological consequences.
• Classification systems allow better communication between surgeons, diagnostic specialties, and IVF specialists.
• They also provide a comparison of therapeutic interventions and measurement of treatment outcomes to allow future investigations in this field.
• The revised American Society for Reproductive Medicine (r-ASRM) classification is one of the classification systems of endometriosis which is only applicable with surgery. It also does not allow a detailed description of the extent of deep endometriosis.
• Upon this, the earlier Enzian classification was developed to detail deep endometriosis in 2003 and 2005. However, this system does not include either ovarian and peritoneal endometriosis or pelvic adhesions.
• Because of these limitations, a more advanced classification system including superficial, deep, and also extragenital endometriosis findings was needed and the #Enzian classification was presented.
• The individual compartments are named with capital letters and the different lesion sizes are numbered 1, 2, and 3.

Lay Summary

The lecture entitled "The #Enzian classification, an essential tool for surgical management of severe endometriosis" was presented by Professor. Jörg Keckstein, from the University Ulm, Germany, at the Annual International Medical Conference of the Endometriosis Foundation of America held in New York on April 1-2, 2023.

Endometriosis is a disease that requires classification due to the heterogeneous and complex nature of the disease. Such a classification system will also enable communication between clinicians, surgeons, and patients. The Revised American Society for Reproductive Medicine (r-ASRM) system which was primarily introduced as a classification system scores intra-abdominal lesions, including adhesions. However, adenomyosis and deep endometriosis affecting the extraperitoneal space, such as the bowel, bladder, and ureters are not assessed. The Enzian system, which was developed later in 2003 and 2005, also evaluates deep endometriosis and adenomyosis, unlike the rASRM classification. Because the Enzian system does not include either ovarian and peritoneal endometriosis or pelvic adhesions, the #Enzian classification was created to evaluate all endometriotic lesions. The earlier review of Dr. Kecktein concerning the issue was published in "Best Practice and Research in Clinical Obstetrics and Gynecology"

The individual compartments are named with capital letters and the different lesion sizes are numbered 1, 2, and 3.

Both the Enzian and the #Enzian classifications correlate with symptoms, imaging modalities such as sonography and magnetic resonance imaging (MRI), surgical complexity, and complications.  

Dr. Keckstein pointed out the details, usability, and benefits of the #Enzian classification, comparing other types of endometriosis classification systems. This comprehensive and informative classification provides identification and control of the clinical progression of endometriosis. It is helpful for clinicians to decide the most appropriate choice for treatment regarding medical or surgical approaches. Patient counseling is more possible using the #Enzian classification at the beginning of management. It also contributes to the collection of more reliable and comparable data for scientific assessment.

Research Source: #Enzian classification, an essential tool for surgical management of severe endometriosis