Factors affecting the technical outcome of catheter-directed sclerotherapy for ovarian endometriomas

Purpose

To identify factors related to technical outcomes of catheter-directed sclerotherapy (CDS) and suggest selection criteria for CDS in patients with ovarian endometrioma.

Method

This retrospective study included patients with endometriomas treated with CDS between November 2015 and June 2023. The characteristics of the endometriomas, including diameter, morphology (unilocular or multilocular), and T2 signal intensity were evaluated using pre-procedure magnetic resonance imaging. Moreover, the size of the catheter (7- or 8.5-French) and route of access (transabdominal vs. transvaginal) was also analyzed. Multivariate logistic regression analyses were used to identify factors associated with the technical outcomes of CDS.

Results

Technical success was defined as successful completion of the following: 1) insertion of a 7- or 8.5-French catheter into the endometrioma, 2) full aspiration of the internal content, and 3) completion of sclerotherapy without ethanol leakage. Of the 323 women (mean age = 32.2 ± 6.0 years) with 401 endometriomas included in our study, technical success was achieved in 377 endometriomas (94.0 %). No major complications were observed. In the multivariate analysis, a diameter < 3 cm (odds ratio, 25.641; p < 0.001), T2 dark signal intensity (odds ratio, 7.462; p = 0.001), and transvaginal access (odds ratio, 4.016; p = 0.004) were associated with technical failure.

Conclusions

Small endometrioma size (<3cm), T2 dark signal intensity, and transvaginal access were identified as significant risk factors for technical failure during catheter-directed sclerotherapy.