Intraoperative enhanced imaging for detection of endometriosis: A systematic review of the literature

Mandi Al-Taher*, Shugi Hsien, Rutger M. Schols, Nehalennia Van Hanegem, Nicole D. Bouvy, Gerard A. J. Dunselman, Laurents P. S. Stassen

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

9 Citations (Web of Science)
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Abstract

The diagnosis of peritoneal endometriosis during laparoscopy may be difficult due to the polymorphic aspects of the lesions. Enhanced imaging using contrast agents has potential to provide a better identification of peritoneal endometriosis. The aim of this systematic review is to provide an overview of the literature on what is known about the intraoperative laparoscopic visual enhancement of peritoneal endometriosis using contrast agents.

A systematic review was done of studies about enhanced imaging during laparoscopy for endometriosis using contrast agents. Clinical studies which contained a description of imaging with a contrast agent and also reported visual findings of endometriosis during laparoscopy, were included.

Nine suitable studies were identified. Intraoperative visualization of endometriosis was analyzed with or without histologic confirmation. Four studies evaluated 5-aminolevulinic acid-induced fluorescence (5-ALA), 1 study evaluated indigo carmine, 2 studies evaluated methylene blue (MB), 1 study evaluated indocyanine green (ICG) and 1 study evaluated so-called bloody peritoneal fluid painting. All studies, with a combined total of 171 included patients, showed potential of enhanced visibility of endometriosis using contrast agents. A combined total of 7 complications, all related to the use of 5-ALA, were reported.

We conclude that the use of contrast-based enhanced imaging during laparoscopy is promising and that it can provide a better visualization of peritoneal endometriosis. However, based on the limited data no technique of preference can yet be identified. (C) 2018 Elsevier B.V. All rights reserved.

Original languageEnglish
Pages (from-to)108-116
Number of pages9
JournalEuropean Journal of Obstetrics & Gynecology and Reproductive Biology
Volume224
DOIs
Publication statusPublished - May 2018

Keywords

  • Endometriosis
  • Minimal invasive surgery
  • Laparoscopy
  • Contrast media
  • Coloring agents
  • Systematic review
  • INDUCED PROTOPORPHYRIN-IX
  • 5-AMINOLEVULINIC ACID
  • PERITONEAL ENDOMETRIOSIS
  • FLUORESCENCE DIAGNOSIS
  • SURGICAL-TREATMENT
  • INDOCYANINE GREEN
  • ESHRE GUIDELINE
  • INDIGO CARMINE
  • SURGERY
  • LESIONS

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