The Gynecologic Surgeon's Approach to Evaluating a Patient With Suspected Endometriosis: A Systematic Review

Abstract

Background: The objective of this review is to assess the most recent literature recommendations for how to approach a patient presenting with chronic pelvic pain (CPP), when a high clinical suspicion of endometriosis exists, to prevent the clinical and economic burden associated with delayed diagnosis.

Methods: An online review of PubMed and Europe PubMed Central was conducted with a final total of 11 articles being reviewed. The search was limited to the preoperative management of these patients, excluding literature focused on the effectiveness of medical vs. surgical management of the disease. There is no main outcome measure.

Results: A thorough history of patient symptomatology and physical exam are paramount to a timely diagnosis of endometriosis. Additionally, the literature supports the use of sonogram as the first-line imaging modality for diagnosis; however, its utility is limited to detection of the two less common forms of the disease, endometrioma and deep peritoneal lesions, with less reliable prediction of superficial implants. If a high clinical suspicion exists for either endometrioma or deep infiltrating disease, magnetic resonance imaging can reliably demonstrate these findings. The gold standard method of laparoscopy for definitive diagnosis is not controversial; however, the literature suggests that proper, sequential evaluation by history, physical and imaging may aid in accurate and timely diagnosis. Delay in the diagnosis of endometriosis creates a significant burden on patient well-being as well as an economic burden on the healthcare system.

Conclusion: Further studies assessing biomarkers of endometriosis and specific features of the disease in time are needed to better understand the etiology and pathogenesis and to subsequently decrease disease burden.

J Clin Gynecol Obstet. 2021;10(2):40-45
doi: https://doi.org/10.14740/jcgo742