ASIA (Shoenfeld's syndrome) due to hysteroscopic Essure sterilization

Utkarsh Chauhan, Brett Cassidy, Jan Willem Cohen Tervaert*

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

Abstract

Essure (TM, Bayer; Leverkusen, Germany) may act as a potential cause of autoimmune/inflammatory syndrome by adjuvants (ASIA). Essure is a device hysteroscopically inserted into the fallopian tubes to elicit a local inflammatory response for permanent sterilization. Patients with ASIA present with a constellation of symptoms including fatigue, cognitive impairment, and arthralgias. It is well known that ASIA is triggered by implantation of foreign material such as breast implants and mesh for hernia repair. In the current study, we present a retrospective cohort of 33 patients electing to remove Essure due to pelvic pain and systemic symptoms consistent with an ASIA diagnosis, and detail a case report of an Essure patient. Furthermore, we reviewed the existing literature on adverse events associated with Essure and studies assessing outcomes following explantation. The concept that Essure may trigger ASIA is further supported by both in vivo and in vitro studies demonstrating immunostimulatory effects of the material components of the device. We conclude that the existing evidence is sufficient to recommend screening of Essure recipients for ASIA symptoms, and where indicated, discussion of the risks and potential benefits of surgical removal.

Original languageEnglish
Article number102979
Number of pages6
JournalAutoimmunity Reviews
Volume20
Issue number12
DOIs
Publication statusPublished - Dec 2021

Keywords

  • Female
  • Humans
  • Hysteroscopy
  • Pregnancy
  • Retrospective Studies
  • Salpingectomy
  • Sterilization
  • Sterilization, Tubal/adverse effects
  • DENDRITIC CELLS
  • DEVICE
  • 2021 MSC: 00-01,99-00
  • SYMPTOMS
  • Essure
  • SILICONE BREAST IMPLANTS
  • Biomaterials
  • ADJUVANT
  • REMOVAL
  • ASIA
  • Hysterectomy and bilateral salpingectomy
  • CASE SERIES
  • Autoimmune syndrome induced by adjuvants

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