Feasibility of Percutaneous Radiofrequency Ablation for Abdominal Wall Endometriosis: A Prospective Pilot Study

Audrey Haquin; Clara Delacroix; Agnes Rode; Dorothee Taconet; Emmanuele Maissiat; Loic Boussel; Gil Dubernard; Charles-André Philip

doi:10.1016/j.jmig.2024.10.022

Feasibility of Percutaneous Radiofrequency Ablation for Abdominal Wall Endometriosis: A Prospective Pilot Study

J Minim Invasive Gynecol. 2024 Oct 25:S1553-4650(24)01468-7. doi: 10.1016/j.jmig.2024.10.022. Online ahead of print.

Authors

Audrey Haquin¹, Clara Delacroix², Agnes Rode¹, Dorothee Taconet¹, Emmanuele Maissiat¹, Loic Boussel³, Gil Dubernard⁴, Charles-André Philip⁵

Affiliations

¹ Radiology department, Croix-Rousse University Hospital, Université Lyon 1, Lyon, France.
² Gynecology department, Croix-Rousse University Hospital, Université Lyon 1, Lyon, France.
³ Radiology department, Croix-Rousse University Hospital, Université Lyon 1, Lyon, France; CREATIS, INSA-Lyon, CNRS, Inserm, CREATIS UMR 5220, (U1294), Université Lyon 1, Lyon, France.
⁴ Gynecology department, Croix-Rousse University Hospital, Université Lyon 1, Lyon, France; LabTAU INSERM (U1032), Université Lyon 1, Lyon, France.
⁵ Gynecology department, Croix-Rousse University Hospital, Université Lyon 1, Lyon, France; LabTAU INSERM (U1032), Université Lyon 1, Lyon, France. Electronic address: charles-andre.philip01@chu-lyon.fr.

PMID: 39490892
DOI: 10.1016/j.jmig.2024.10.022

Abstract

Study objective: To assess the feasibility of percutaneous radiofrequency ablation (PRFA) of anterior abdominal wall endometriosis (AWE) lesions and to describe its efficacy on clinical symptoms and on the volume of the lesion.

Design: Interventional, prospective, non-comparative, phase 1 clinical trial.

Setting: Patients consulting at the multidisciplinary endometriosis expert center at Croix Rousse University Hospital (Hospices Civils de Lyon).

Patients: Ten patients with 1 to 3 AWE lesions treated by PRFA with 6 months follow-up.

Interventions: PRFA of AWE lesions were performed under ultrasound guidance. Initial power ranged from 3 to 10 W, with progressive increases in power. The thermal effect in the ablation zone was monitored in real time (appearance of hyperechoic signals). A contrast-enhanced ultrasound check was also carried out. We used multiShot technique until the entire nodule was covered by the hyperechogenic cloud.

Measurements and main results: Ten patients (12 nodules) were positively treated from 25/06/2020 to 27/07/2022, 8 under local anesthesia and 2 under general anesthesia, which represented 100% feasibility. Nine patients had previous caesarean section. At 6 months the nodule pain at palpation disappeared for 9 patients (90%), mean cyclic pain VAS significantly decreased from 5.7 points (0.9 SD 0.9 VS 6.6 SD 3.2 p=.03) and non-cyclic pain from 3.8 points (0.8 SD 1.3 vs 4.6 SD 3.3 p=.02). Patients reported a significant improvement of their quality of life at 6 months (SF36 total score increase by 218 points p<.01). We observed a significant reduction of 78% in the volume of the nodule at 6 months on MRI (1.2cm³ SD 1.3 vs 5.4cm³ SD 8.2 p<.01); 11/12 treated nodules were non-vascularized/enhanced on post-procedure MRI. All Patients were treated on an outpatient basis. We report one severe adverse event (incisional hernia).

Conclusion: PRFA is feasible and may be a clinically effective treatment for AWE. https://clinicaltrials.gov/study/NCT04333017 Clinical trial registry number: NCT04333017.

Keywords: abdominal wall endometriosis; extra pelvic endometriosis; percutaneous radiofrequency ablation.

Associated data

ClinicalTrials.gov/NCT04333017