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Endometriosis: HELP
Articles from Barts and the London Hospital School of Medicine and Dentistry
Based on 24 articles published since 2010
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These are the 24 published articles about Endometriosis that originated from Barts and the London Hospital School of Medicine and Dentistry during 2010-2020.
 
+ Citations + Abstracts
1 Review Recent advances in understanding and managing chronic pelvic pain in women with special consideration to endometriosis. 2020

Ball, Elizabeth / Khan, Khalid S. ·Department of Obstetrics and Gynaecology, The Royal London Hospital, Barts Health NHS Trust, London, UK. · Women's Health Research Unit, Yvonne Carter Building, Queen Mary University of London, London, UK. · Centre for Maternal & Child Health Research, School of Health Sciences, City University of London, London, UK. · Department of Public Health, University of Granada, Granada, Spain. ·F1000Res · Pubmed #32089831.

ABSTRACT: Chronic pelvic pain (CPP) in women is defined variably, but for clinical use it is cyclical or non-cyclical pain of at least 3-6 months' duration. It has major impacts on individuals and society. There are both structural and idiopathic causes. Whereas CPP is not curable in many cases, it is treatable. The most promising approach is multidisciplinary patient-centered care including cause-directed therapy, lifestyle changes, talking therapies, meditation, acupuncture, and physiotherapy (this is not a complete list). One of the most common structural causes for CPP is endometriosis. This review investigates current scientific concepts and recent innovations in this field as well as for CPP in general.

2 Review Laparoscopic Excision Versus Ablation for Endometriosis-associated Pain: An Updated Systematic Review and Meta-analysis. 2017

Pundir, Jyotsna / Omanwa, Kireki / Kovoor, Elias / Pundir, Vishal / Lancaster, Gillian / Barton-Smith, Peter. ·Centre for Reproductive Medicine, St Bartholomew's Hospital, West Smithfield, London, United Kingdom. Electronic address: jyotsnapundir@yahoo.com. · Department of Obsterics and Gynaecology, University of Nairobi, Nairobi, Kenya. · Maidstone and Tunbridge Wells NHS Trust, Kent, United Kingdom. · Institute of Primary Care and Health Sciences, Keele University, Newcastle, United Kingdom. · Princess Grace Hospital, London, United Kingdom. ·J Minim Invasive Gynecol · Pubmed #28456617.

ABSTRACT: The aim of this study was to update the evidence on the surgical management of endometriosis-associated pain. Does laparoscopic excision offer any benefits over laparoscopic ablation? This is a systematic review and meta-analysis in which we searched MEDLINE, Embase, Institute for Scientific Information conference proceedings, the International Standard Randomised Controlled Trial Number registry, the Register and Meta-register for randomized controlled trials, the World Health Organization trials search portal, the Cochrane Library, and the British Library of electronic theses. Three randomized controlled trials were included, which enrolled 335 participants with a sample size per study ranging from 24 to 178 participants. Of these 3 studies, data from 2 could be pooled for meta-analysis. The primary outcome measure was the reduction in the visual analog scale score for dysmenorrhea. The secondary outcome measures included the reduction in the visual analog scale score for dyspareunia, dyschezia, and chronic pelvic pain and the reduction in Endometriosis Health Profile-30 core pain scores. The meta-analysis showed that the excision group had a significantly greater reduction in symptoms of dysmenorrhea (mean difference [MD] = 0.99; 95% confidence interval [CI], -0.02 to 2.00; p = .05) and dyschezia (MD = 1.31; 95% CI, 0.33-2.29; p = .009) compared with ablation. The symptoms of dyspareunia showed a nonsignificant benefit with excision (MD = 0.96; 95% CI, -0.07 to 1.99; p = .07). Data from 1 study showed a significant reduction in chronic pelvic pain (MD = 2.57; 95% CI, 1.27-3.87; p = .0001) and Endometriosis Health Profile-30 core pain scores (MD = 13.20; 95% CI, 3.70-22.70; p = .006) with the excision group compared with the ablation group. The limited available evidence shows that at 12 months postsurgery, symptoms of dysmenorrhea, dyschezia, and chronic pelvic pain secondary to endometriosis showed a significantly greater improvement with laparoscopic excision compared with ablation.

3 Review Googling endometriosis: a systematic review of information available on the Internet. 2017

Hirsch, Martin / Aggarwal, Shivani / Barker, Claire / Davis, Colin J / Duffy, James M N. ·Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Yvonne Carter Building, London, United Kingdom. · Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, United Kingdom; Radcliffe Women's Health Patient and Public Involvement Group, University of Oxford, Oxford, United Kingdom. · Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, United Kingdom; Balliol College, University of Oxford, Oxford, United Kingdom. Electronic address: james.duffy@balliol.ox.ac.uk. ·Am J Obstet Gynecol · Pubmed #27840143.

ABSTRACT: BACKGROUND: The demand for health information online is increasing rapidly without clear governance. OBJECTIVE: We aim to evaluate the credibility, quality, readability, and accuracy of online patient information concerning endometriosis. STUDY DESIGN: We searched 5 popular Internet search engines: aol.com, ask.com, bing.com, google.com, and yahoo.com. We developed a search strategy in consultation with patients with endometriosis, to identify relevant World Wide Web pages. Pages containing information related to endometriosis for women with endometriosis or the public were eligible. Two independent authors screened the search results. World Wide Web pages were evaluated using validated instruments across 3 of the 4 following domains: (1) credibility (White Paper instrument; range 0-10); (2) quality (DISCERN instrument; range 0-85); and (3) readability (Flesch-Kincaid instrument; range 0-100); and (4) accuracy (assessed by a prioritized criteria developed in consultation with health care professionals, researchers, and women with endometriosis based on the European Society of Human Reproduction and Embryology guidelines [range 0-30]). We summarized these data in diagrams, tables, and narratively. RESULTS: We identified 750 World Wide Web pages, of which 54 were included. Over a third of Web pages did not attribute authorship and almost half the included pages did not report the sources of information or academic references. No World Wide Web page provided information assessed as being written in plain English. A minority of web pages were assessed as high quality. A single World Wide Web page provided accurate information: evidentlycochrane.net. Available information was, in general, skewed toward the diagnosis of endometriosis. There were 16 credible World Wide Web pages, however the content limitations were infrequently discussed. No World Wide Web page scored highly across all 4 domains. CONCLUSION: In the unlikely event that a World Wide Web page reports high-quality, accurate, and credible health information it is typically challenging for a lay audience to comprehend. Health care professionals, and the wider community, should inform women with endometriosis of the risk of outdated, inaccurate, or even dangerous information online. The implementation of an information standard will incentivize providers of online information to establish and adhere to codes of conduct.

4 Review Vitamin D and chronic diseases: the current state of the art. 2017

Muscogiuri, Giovanna / Altieri, Barbara / Annweiler, Cedric / Balercia, Giancarlo / Pal, H B / Boucher, Barbara J / Cannell, John J / Foresta, Carlo / Grübler, Martin R / Kotsa, Kalliopi / Mascitelli, Luca / März, Winfried / Orio, Francesco / Pilz, Stefan / Tirabassi, Giacomo / Colao, Annamaria. ·Ios and Coleman Medicina Futura Medical Center, University "Federico II", Naples, Italy. giovanna.muscogiuri@gmail.com. · Department of Endocrinology and Metabolic Diseases, Catholic University of the Sacred Heart, Rome, Italy. · Division of Geriatric Medicine, Department of Neuroscience, Angers University Hospital, University Memory Clinic, UPRES EA 4638, University of Angers, UNAM, Angers, France. · Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Robarts Research Institute, The University of Western Ontario, London, ON, Canada. · Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy. · Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary. · The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK. · Vitamin D Council, San Luis Obispo, CA, USA. · Department of Medicine, Operative Unit of Andrology and Medicine of Human Reproduction, University of Padova, Padua, Italy. · Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland. · Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria. · Division of Endocrinology and Metabolism, Department of Medicine, AHEPA University Hospital, Thessaloníki, Greece. · Comando Brigata Alpina "Julia"/Multinational Land Force, Medical Service, Udine, Italy. · Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany. · Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria. · Synlab Academy, Synlab Holding Germany GmbH, Mannheim, Augsburg, Germany. · Department of Endocrinology and Diabetology, Fertility Techniques Structure, University Hospital "S. Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy. · Department of Sports Science and Wellness, "Parthenope" University Naples, Naples, Italy. · Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. · Department of Clinical Medicine and Surgery, University "Federico II", Naples, Italy. ·Arch Toxicol · Pubmed #27425218.

ABSTRACT: The objective was to provide the current state of the art regarding the role of vitamin D in chronic diseases (osteoporosis, cancer, cardiovascular diseases, dementia, autism, type 1 and type 2 diabetes mellitus, male and female fertility). The document was drawn up by panelists that provided their contribution according to their own scientific expertise. Each scientific expert supplied a first draft manuscript on a specific aspect of the document's topic that was subjected to voting by all experts as "yes" (agreement with the content and/or wording) or "no" (disagreement). The adopted rule was that statements supported by ≥75 % of votes would be immediately accepted, while those with <25 % would be rejected outright. Others would be subjected to further discussion and subsequent voting, where ≥67 % support or, in an eventual third round, a majority of ≥50 % would be needed. This document finds that the current evidence support a role for vitamin D in bone health but not in other health conditions. However, subjects with vitamin D deficiency have been found to be at high risk of developing chronic diseases. Therefore, although at the present time there is not sufficient evidence to recommend vitamin D supplementation as treatment of chronic diseases, the treatment of vitamin D deficiency should be desiderable in order to reduce the risk of developing chronic diseases.

5 Review A Case of Stage 4B Seromucinous Ovarian Borderline Tumor With Endometriosis and Review of the Literature. 2017

Newton, Claire L / Brockbank, Elly / Singh, Naveena / Faruqi, Asma. ·Royal London Hospital, Whitechapel Road, London, United Kingdom. ·Int J Gynecol Pathol · Pubmed #27362901.

ABSTRACT: Ovarian mucinous borderline tumors are traditionally divided into 2 morphologic groups: endocervical type, also known as seromucinous, and intestinal type. We present a case of stage 4B seromucinous ovarian borderline tumor with endometriosis and review the literature. At the time of writing, this is believed to be the first case of a seromucinous borderline tumor reported at such an advanced stage.

6 Review Diagnostic accuracy of cancer antigen 125 for endometriosis: a systematic review and meta-analysis. 2016

Hirsch, M / Duffy, Jmn / Davis, C J / Nieves Plana, M / Khan, K S / Anonymous10841108. ·Women's Health Research Unit, The Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK. m.hirsch@qmul.ac.uk. · Balliol College, University of Oxford, Oxford, UK. · Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. · Women's Health Research Unit, The Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK. · Madrid Cochrane Collaboration Centre, Francisco de Vitoria University, Madrid, Spain. · Clinical Biostatistics Unit, Ramon y Cajal Institute of Research (IRYCIS) and CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain. ·BJOG · Pubmed #27173590.

ABSTRACT: BACKGROUND: The development of a non-invasive and accurate diagnostic biomarker for endometriosis is urgently needed. OBJECTIVE: Evaluate the diagnostic accuracy of serum cancer antigen 125 (CA 125) for endometriosis. SEARCH STRATEGY: We searched EMBASE, MEDLINE, and Web of Science from inception to January 2016. SELECTION CRITERIA: Diagnostic accuracy studies of serum CA 125 (index test) for histologically confirmed endometriosis (reference standard) were included. DATA COLLECTION AND ANALYSIS: Two authors independently selected trials, extracted study characteristics and data. Methodological quality was assessed using Quality Assessment of Comparative Diagnostic Accuracy Studies (QUADAS-2) checklist. MAIN RESULTS: Twenty-two studies (16 cohort, six case-control), 3626 participants, were identified. Bivariate hierarchical models were used to pool accuracy data of 14 studies (2920 participants) using CA 125 ≥ 30 units/ml. Pooled specificity was 93% (95% CI 89-95%) and sensitivity 52% (95% CI 38-66%). CA 125 was significantly more sensitive for the diagnosis of moderate or severe endometriosis compared with minimal disease (63%, 95% CI 47-77% versus 24%, 95%CI 19-32%, P-value = 0.001). CONCLUSIONS: CA 125 performs well as a rule-in test facilitating expedited diagnosis and ensuring investigation and treatment can be confidently tailored for the management of endometriosis. Unfortunately, a negative test, CA 125 < 30 units/ml, is unable to rule out endometriosis. TWEETABLE ABSTRACT: Blood test CA 125: a rule-in test for the diagnosis of women presenting with symptoms of endometriosis.

7 Review Variation in outcome reporting in endometriosis trials: a systematic review. 2016

Hirsch, Martin / Duffy, James M N / Kusznir, Jennie O / Davis, Colin J / Plana, Maria N / Khan, Khalid S / Anonymous1610855. ·Women's Health Research Unit, Barts and The London School of Medicine and Dentistry, Whitechapel, London, United Kingdom. Electronic address: m.hirsch@qmul.ac.uk. · Balliol College, University of Oxford, Oxford, United Kingdom. · Women's Health Research Unit, Barts and The London School of Medicine and Dentistry, Whitechapel, London, United Kingdom. · Madrid Cochrane Collaboration Centre, Francisco de Vitoria University, Madrid, Spain; Clinical Biostatistics Unit, Ramon y Cajal Institute of Research and Centro de Investigación Biomédica en Red Epidemiology and Public Health, Madrid, Spain. ·Am J Obstet Gynecol · Pubmed #26778385.

ABSTRACT: OBJECTIVE: We reviewed the outcomes and outcome measures reported in randomized controlled trials and their relationship with methodological quality, year of publication, commercial funding, and journal impact factor. DATA SOURCES: We searched the following sources: (1) Cochrane Central Register of Controlled Trials, (2) Embase, and (3) MEDLINE from inception to November 2014. STUDY ELIGIBILITY: We included all randomized controlled trials evaluating a surgical intervention with or without a medical adjuvant therapy for the treatment of endometriosis symptoms. STUDY DESIGN: Two authors independently selected trials, assessed methodological quality (Jadad score; range, 1-5), outcome reporting quality (Management of Otitis Media with Effusion in Cleft Palate criteria; range, 1-6), year of publication, impact factor in the year of publication, and commercial funding (yes or no). Univariate and bivariate analyses were performed using Spearman Rh and Mann-Whitney U tests. We used a multivariate linear regression model to assess relationship associations between outcome reporting quality and other variables. RESULTS: There were 54 randomized controlled trials (5427 participants), which reported 164 outcomes and 113 outcome measures. The 3 most commonly reported primary outcomes were dysmenorrhea (10 outcome measures; 23 trials), dyspareunia (11 outcome measures; 21 trials), and pregnancy (3 outcome measures; 26 trials). The median quality of outcome reporting was 3 (interquartile range 4-2) and methodological quality 3 (interquartile range 5-2). Multivariate linear regression demonstrated a relationship between outcome reporting quality with methodological quality (β = 0.325; P = .038) and year of publication (β = 0.067; P = .040). No relationship was demonstrated between outcome reporting quality with journal impact factor (Rho = 0.190; P = .212) or commercial funding (P = .370). CONCLUSION: Variation in outcome reporting within published endometriosis trials prohibits comparison, combination, and synthesis of data. This limits the usefulness of research to inform clinical practice, enhance patient care, and improve patient outcomes. In the absence of a core outcome set for endometriosis we recommend the use of the 3 most common pain (dysmenorrhea, dyspareunia, and pelvic pain) and subfertility (pregnancy, miscarriage, and live birth) outcomes. International consensus among stakeholders is needed to establish a core outcome set for endometriosis trials.

8 Review Chronic pelvic pain: how does noninvasive imaging compare with diagnostic laparoscopy? 2015

Tirlapur, Seema A / Daniels, Jane P / Khan, Khalid S / Anonymous2780846. ·aWomen's Health Research Unit, Barts and the London School of Medicine, Queen Mary University of London bBarts Health NHS Trust, Newham University Hospital, London cBirmingham Clinical Trials Unit, School of Cancer Sciences, Robert Aitken Institute, University of Birmingham, Birmingham dBarts Health NHS Trust, The Royal London Hospital, London, UK. ·Curr Opin Obstet Gynecol · Pubmed #26485454.

ABSTRACT: PURPOSE OF REVIEW: Chronic pelvic pain (CPP) has an annual prevalence of 38/1000 in the UK, with coexisting pathologies often present. Diagnostic laparoscopy has long been the gold standard diagnostic test, but with up to 40% showing no abnormality, we explore the value of noninvasive imaging, such as pelvic ultrasound and MRI. RECENT FINDINGS: A literature review from inception until January 2015 of the following databases: PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica database, and System for Information on Grey Literature in Europe were performed to identify published studies assessing the usefulness of ultrasound, MRI, and laparoscopy in the diagnosis of CPP. Three studies (194 women) addressed their comparative performance in patients with endometriosis, showing the sensitivity of ultrasound ranged between 58 and 88.5%; MRI was 56-91.5% and in the one study using histology as its reference standard, the sensitivity of laparoscopy was 85.7%. Noninvasive imaging has the additional benefit of being well tolerated, safer, and cheaper than surgery. SUMMARY: CPP, by nature of its multifactorial causation, can be difficult to manage and often requires a multidisciplinary team. Ultrasound and MRI may provide information about the presence or lack of abnormality, which would allow general practitioners or office gynaecologists to initiate treatment and think about surgery as a second-line investigative tool.

9 Review Preoperative assessment and diagnosis of endometriosis: are we any closer? 2015

Hirsch, Martin / Davis, Colin J. ·aCentre for Reproductive Medicine, St Bartholomew's Hospital, Barts Health NHS Trust bWomen's Health Research Unit, Barts and the London School of Medicine and Dentistry, Whitechapel, London, UK. ·Curr Opin Obstet Gynecol · Pubmed #26125979.

ABSTRACT: PURPOSE OF REVIEW: The management of endometriosis has progressed vastly with medical treatments providing a large role in controlling endometriosis symptoms. Despite these advances we still lack an accurate noninvasive test to diagnose endometriosis. This has a large role in the delay to diagnosis, management and progression of the disease amongst a population that is choosing to conceive later. RECENT FINDINGS: Endometriosis is now thought to affect 1 in 10 women with patient annual healthcare costs estimated at &OV0556;9579. The diagnosis of this disease is still delayed by an average of 6-9 years allowing disease and symptom progression. Researchers have assessed a wide variety of noninvasive markers from urinary derivatives to MRI. There has been limited success in producing a highly sensitive and specific preoperative test for endometriosis. Novel markers such as miRNA provide the most encouraging diagnostic accuracy. SUMMARY: The development of a noninvasive accurate marker for endometriosis is a research target and priority of the European Society of Human Reproduction and Embryology. The current markers in use have moderate sensitivity and sensitivity. The inflammatory basis for the disease underpins many biomarkers but also many other concomitant diseases reducing accuracy and increasing false positive results.

10 Review Review of the management of ovarian endometriosis: paradigm shift towards conservative approaches. 2014

Psaroudakis, Dimitrios / Hirsch, Martin / Davis, Colin. ·Centre for Reproductive Medicine, St Bartholomew's Hospital, London, UK. ·Curr Opin Obstet Gynecol · Pubmed #24978850.

ABSTRACT: PURPOSE OF REVIEW: To describe the current consensus regarding the modern management of ovarian endometriosis and summarize the recent evidence that led to a shift in the management recommendations. RECENT FINDINGS: The vast majority of the recent studies demonstrate an adverse effect of surgery on ovarian reserve markers, whereas convincing evidence of a benefit of surgery on fertility outcomes is lacking. Current research is focussing on identifying the optimal surgical technique that affords minimal injury to ovarian function. New medical treatment options in the form of aromatase inhibitors are emerging, whereas the evidence for a role of ultrasound-guided drainage and sclerotherapy is scarce and unconvincing. SUMMARY: Consensus from Europe and the USA is for a conservative approach to the treatment of ovarian endometriosis, with early recourse to assisted reproductive technology for subfertility. Surgery is currently only being advised for severe pain or difficult access to growing follicles and only after careful counselling regarding the potential adverse effect on ovarian reserve. Research has still not identified the optimal technique for treating ovarian endometriosis. Laparoscopic ovarian cystectomy not only offers the lowest risk of recurrence and the highest chance of spontaneous pregnancy rate, but also risks significant injury to ovarian function. Medical treatment offers temporary symptom relief but does not improve the fertility outcomes, and the role of ultrasound-guided drainage remains to be established.

11 Review Laparoscopic surgery for endometriosis. 2014

Duffy, James M N / Arambage, Kirana / Correa, Frederico J S / Olive, David / Farquhar, Cindy / Garry, Ray / Barlow, David H / Jacobson, Tal Z. ·Women's Health Research Unit, Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, 58 Turner Street, London, Greater London, UK, E1 2AB. ·Cochrane Database Syst Rev · Pubmed #24696265.

ABSTRACT: BACKGROUND: Endometriosis is the presence of endometrial glands or stroma in sites other than the uterine cavity and is associated with pain and subfertility. Surgical interventions aim to remove visible areas of endometriosis and restore the anatomy. OBJECTIVES: To assess the effectiveness and safety of laparoscopic surgery in the treatment of painful symptoms and subfertility associated with endometriosis. SEARCH METHODS: This review has drawn on the search strategy developed by the Cochrane Menstrual Disorders and Subfertility Group including searching CENTRAL, MEDLINE, EMBASE, PsycINFO, and trial registries from inception to July 2013. SELECTION CRITERIA: Randomised controlled trials (RCTs) were selected in which the effectiveness and safety of laparoscopic surgery used to treat pain or subfertility associated with endometriosis was compared with any other laparoscopic or robotic intervention, holistic or medical treatment or diagnostic laparoscopy only. DATA COLLECTION AND ANALYSIS: Selection of studies, assessment of trial quality and extraction of relevant data were performed independently by two review authors with disagreements resolved by a third review author. The quality of evidence was evaluated using GRADE methods. MAIN RESULTS: Ten RCTs were included in the review. The studies randomised 973 participants experiencing pain or subfertility associated with endometriosis. Five RCTs compared laparoscopic ablation or excision versus diagnostic laparoscopy only. Two RCTs compared laparoscopic excision versus diagnostic laparoscopy only. Two RCTs compared laparoscopic excision versus ablation. One RCT compared laparoscopic ablation versus diagnostic laparoscopy and injectable gonadotropin-releasing hormone analogue (GnRHa) (goserelin) with add-back therapy. Common limitations in the primary studies included lack of clearly-described blinding, failure to fully describe methods of randomisation and allocation concealment, and risk of attrition bias.Laparoscopic surgery was associated with decreased overall pain (measured as 'pain better or improved') compared with diagnostic laparoscopy, both at six months (odds ratio (OR) 6.58, 95% CI 3.31 to 13.10, 3 RCTs, 171 participants, I(2) = 0%, moderate quality evidence) and at 12 months (OR 10.00, 95% CI 3.21 to 31.17, 1 RCT, 69 participants, low quality evidence). Compared with diagnostic laparoscopy, laparoscopic surgery was also associated with an increased live birth or ongoing pregnancy rate (OR 1.94, 95% CI 1.20 to 3.16, P = 0.007, 2 RCTs, 382 participants, I(2) = 0%, moderate quality evidence) and increased clinical pregnancy rate (OR 1.89, 95% CI 1.25 to 2.86, P = 0.003, 3 RCTs, 528 participants, I(2) = 0%, moderate quality evidence). Two studies collected data on adverse events (including infection, vascular and visceral injury and conversion to laparotomy) and reported no events in either arm. Other studies did not report this outcome. The similar effect of laparoscopic surgery and diagnostic laparotomy on the rate of miscarriage per pregnancy was imprecise (OR 0.94, 95% CI 0.35 to 2.54, 2 studies, 112 women, moderate quality evidence).When laparoscopic ablation was compared with diagnostic laparoscopy plus medical therapy (GnRHa plus add-back therapy), more women in the ablation group reported that they were pain free at 12 months (OR 5.63, 95% CI 1.18 to 26.85, 1 RCT, 35 participants, low quality evidence).The difference between laparoscopic ablation and laparoscopic excision in the proportion of women reporting overall pain relief at 12 months on a VAS 0 to 10 pain scale was 0 (95% CI -1.22 to 1.22, P = 1.00, 1 RCT, 103 participants, low quality evidence). AUTHORS' CONCLUSIONS: There is moderate quality evidence that laparoscopic surgery to treat mild and moderate endometriosis reduces overall pain and increases live birth or ongoing pregnancy rates. There is low quality evidence that laparoscopic excision and ablation were similarly effective in relieving pain, although there was only one relevant study. More research is needed considering severe endometriosis, different types of pain associated with endometriosis (for example dysmenorrhoea (pain with menstruation)) and comparing laparoscopic interventions with holistic and medical interventions. There was insufficient evidence on adverse events to allow any conclusions to be drawn regarding safety.

12 Review Cutaneous endometriosis: a plastic surgery perspective. 2013

Din, Asmat H / Verjee, Liaquat Suleman / Griffiths, Matthew A. ·St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, CM1 7ET, UK. asmatdin@hotmail.com ·J Plast Reconstr Aesthet Surg · Pubmed #22784788.

ABSTRACT: Cutaneous endometriosis is a rare skin pathology that may present to the gynaecologist, general surgeon, dermatologist, or plastic surgeon. It is often misdiagnosed due to its rarity and variable appearance. In the current literature recommendations for its management vary greatly. We present a case of cutaneous endometriosis presenting to a plastic surgery service, as well as a review of the literature. Cutaneous endometriosis should be considered as a differential in any female presenting with an umbilical lesion, and should be diagnosed histiologically following an excision biopsy with 2 mm margins.

13 Review Does minimally invasive surgery for endometriosis improve pelvic symptoms and quality of life? 2012

Deguara, Christine S / Pepas, Litha / Davis, Colin. ·Centre for Reproductive Medicine, St. Bartholomew's Hospital London, UK. christine.deguara@bartsandthelondon.nhs.uk ·Curr Opin Obstet Gynecol · Pubmed #22729092.

ABSTRACT: PURPOSE OF REVIEW: Endometriosis is a common gynaecological disorder estimated to affect over 70 million women worldwide. In this review we aim to give an overview of postoperative symptoms and look at factors influencing therapeutic choices and surgical techniques. RECENT FINDINGS: A wide range of physical and psychological factors contribute to the symptoms of disease. Patients suffer from impaired quality of life, depression, anxiety and chronic and acute pain. Validated questionnaires have been used to assess patient response. Surgical excision of endometriosis improves dyspareunia and the quality of sex life of patients. It is superior in outcomes to medical therapy in achieving increased pregnancy rates. Catastrophizing and biopsychosocial variables are implicated in the severity of pain experienced in patients with endometriosis. Patients with endometriosis score lower on quality of life assessments and the addition of psychosomatic therapy to medical treatments has shown to improve the emotional status of patients with improved treatment outcomes. SUMMARY: Despite its prevalence, there is no optimal treatment for endometriosis; recurrence of disease is a common problem. Laparoscopic surgery compared with medical therapies shows improved patient satisfaction outcomes in general health, quality of life and emotional wellbeing. Management of this varied aetiology improves in the context of a multidisciplinary team.

14 Review Update on the surgical management of adenomyosis. 2012

Pepas, Litha / Deguara, Christine / Davis, Colin. ·Department of Obstetrics and Gynaecology, Centre for Reproductive Medicine and Surgery, St Bartholomew's Hospital, West Smithfield, London, UK. Litha.Pepas@bartsandthelondon.nhs.uk ·Curr Opin Obstet Gynecol · Pubmed #22614675.

ABSTRACT: PURPOSE OF REVIEW: Adenomyosis is a benign gynaecological condition associated with menstrual symptoms and pelvic pain in premenopausal women, it has also been linked to subfertility. Improvement in ultrasound and MRI imaging has allowed accurate diagnosis of this condition prior to histological confirmation. Patients opting for surgical management need to be counselled regarding the surgical options available. This review summarizes the surgical management of adenomyosis and reviews the recent surgical developments. RECENT FINDINGS: For patients who wish to preserve their fertility, cytoreductive surgery is an option in centres with surgical expertise. Recently, modified surgical procedures to remove extensive adenomyosis known as an adenomyomectomy have been described. These operations may enhance subsequent fertility. SUMMARY: Access to accurate imaging modalities such as MRI and transvaginal ultrasound allows for adequate patient counselling preoperatively. Depending on the fertility requirements and the extent of adenomyosis, patients can be offered various surgical treatment options including laparoscopic hysterectomy or adenomyomectomy.

15 Review Laparoscopic conservative management of ureteral endometriosis. 2010

Camanni, Marco / Delpiano, Elena M / Bonino, Luca / Deltetto, Francesco. ·GINTEAM Unit of Minimally Invasive Gynaecology, Corso Marconi, 10125 Turin, Italy. Colin.Davis@bartsandthelondon.nhs.uk ·Curr Opin Obstet Gynecol · Pubmed #20610998.

ABSTRACT: PURPOSE OF REVIEW: The surgical management of deeply infiltrating endometriosis involving the ureter is a complex procedure that requires an accurate balance between the need for complete excision of endometriotic foci and the need to avoid any morbidity associated with radical surgery. Owing to its rarity, a clear surgical strategy to deal with this condition (e.g. ureterolysis vs. ureteroneocystostomy) has not as yet been identified. RECENT FINDINGS: A few studies present data about the conservative management of ureteral endometriosis. We reported the experience of some surgical topics dealing with ureteral endometriosis and their strategies for the conservative treatment of this condition. SUMMARY: Ureterolysis could be used as the initial surgical step for patients with ureteral endometriosis. For patients displaying extended severe ureteral involvement, stenosis, or moderate or severe hydronephrosis with a high risk of having intrinsic ureteral disease, ureteroneocystostomy is likely to be a wiser surgical strategy. Moreover the crucial role of the primary surgeon in the treatment definition will hardly be replaced by objective reproducible referral pattern.

16 Article Management of ovarian endometriomas: many options…but difficult decisions. 2019

Al Wattar, B H. ·Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. · Warwick Medical School, University of Warwick, Coventry, UK. ·BJOG · Pubmed #31188521.

ABSTRACT: -- No abstract --

17 Article Diagnosis and management of endometriosis: a systematic review of international and national guidelines. 2018

Hirsch, M / Begum, M R / Paniz, É / Barker, C / Davis, C J / Duffy, Jmn. ·Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, London, UK. · Department of Obstetrics and Gynaecology, Royal Free Hospital NHS Trust, London, UK. · Radcliffe Women's Health Patient and Public Involvement Group, University of Oxford, Oxford, UK. · Balliol College, University of Oxford, Oxford, UK. · Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. ·BJOG · Pubmed #28755422.

ABSTRACT: BACKGROUND: The development of clinical guidelines requires standardised methods informed by robust evidence synthesis. OBJECTIVES: We evaluated the methodological quality of endometriosis guidelines, mapped their recommendations, and explored the relationships between recommendations and research evidence. SEARCH STRATEGY: We searched EMBASE, MEDLINE, and PubMed from inception to February 2016. SELECTION CRITERIA: We included guidelines related to the diagnosis and management of endometriosis. DATA COLLECTION AND ANALYSIS: The search strategy identified 879 titles and abstracts. We include two international and five national guidelines. Four independent authors assessed the methodological quality of the included guidelines, using the Appraisal of Guidelines for Research & Evaluation (AGREE-II) instrument, and systematically extracted the guideline recommendations and supporting research evidence. MAIN RESULTS: One hundred and fifty-two different recommendations were made. Ten recommendations (7%) were comparable across guidelines. The European Society of Human Reproduction and Embryology was objectively evaluated as the highest quality guideline (methodological quality score: 88/100). There was substantial variation between the supporting evidence presented by individual guidelines for comparable recommendations. Forty-two recommendations (28%) were not supported by research evidence. No guideline followed the standardised guideline development methods (AGREE-II). CONCLUSIONS: There is substantial variation in the recommendations and methodological quality of endometriosis guidelines. Future guidelines should be developed with reference to high-quality methods in consultation with key stakeholders, including women with endometriosis, ensuring that their scope can truly inform clinical practice and eliminate unwarranted and unjustified variations in clinical practice. TWEETABLE ABSTRACT: #Endometriosis guidelines vary in recommendations and quality. @EndometriosisUK.

18 Article Diagnostic accuracy of Cancer Antigen 125 (CA125) for endometriosis in symptomatic women: A multi-center study. 2017

Hirsch, Martin / Duffy, James M N / Deguara, Christine S / Davis, Colin J / Khan, Khalid S. ·Women's Health Research Unit, The Blizard Institute, Barts and the London School of Medicine and Dentistry, Yvonne Carter Building, 58 Turner Street, Whitechapel, London, E1 2AB, United Kingdom; Royal Free London NHS Trust, London, NW3 2QG, United Kingdom. Electronic address: m.hirsch@qmul.ac.uk. · Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, OX1 2JD, United Kingdom. · Centre for Reproductive Medicine, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, EC1A 7BE, United Kingdom. · Women's Health Research Unit, The Blizard Institute, Barts and the London School of Medicine and Dentistry, Yvonne Carter Building, 58 Turner Street, Whitechapel, London, E1 2AB, United Kingdom. ·Eur J Obstet Gynecol Reprod Biol · Pubmed #27987404.

ABSTRACT: STUDY OBJECTIVE: To assess the diagnostic accuracy of serum Cancer Antigen 125 (CA 125)≥30units/milliliter (u/ml) for diagnosing endometriosis in symptomatic women. STUDY DESIGN: Prospective observational cohort study including patients with symptoms of pelvic pain or subfertility undergoing elective diagnostic laparoscopy at two tertiary referral hospitals. We excluded patients suspected to have other gynecological pathology. We evaluated the accuracy of serum CA 125 (index test) with histologically confirmed endometriosis (reference standard). MAIN RESULTS: Fifty-eight consecutive women recruited between October 2013 to March 2015. Women with endometriosis had a higher CA 125 level than those without endometriosis (mean 54.7+/-71.6 vs 16.2+/- 8.0). The specificity of CA 125≥30u/ml was 96% (95% CI 81.7-99.9%) and sensitivity was 57% (95% CI 37.4-74.5%). The positive likelihood ratio for the histological presence of endometriosis with a CA 125≥30u/ml was 15.8 (95% CI 2.3-112) providing a post-test probability of 94% (95% CI 71%-99%) in women with pelvic pain or subfertility. The area under the curve, 0.85 (95% CI 0.74-0.96) indicates high test accuracy. CONCLUSIONS: CA 125≥30u/ml is highly predictive of endometriosis in women with symptoms of pain and/or subfertility. CA 125 should be considered as a rule-in test for expediting the diagnosis and management of endometriosis, CA 125 <30u/ml is, however, unable to rule out endometriosis.

19 Article Protocol for developing, disseminating and implementing a core outcome set for endometriosis. 2016

Hirsch, Martin / Duffy, James M N / Barker, Claire / Hummelshoj, Lone / Johnson, Neil P / Mol, Ben / Khan, Khalid S / Farquhar, Cindy / Anonymous2391111. ·Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, London, UK. · Balliol College, University of Oxford, Oxford, UK. · Radcliffe Women's Health Patient Participation Group, University of Oxford, Oxford, UK. · World Endometriosis Society, Vancouver, British Columbia, Canada. · World Endometriosis Research Foundation, London, UK. · Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia. · Cochrane Gynaecology and Fertility Group, University of Auckland, Auckland, New Zealand. ·BMJ Open · Pubmed #28003300.

ABSTRACT: INTRODUCTION: Endometriosis is a common gynaecological disease characterised by pain and subfertility. Randomised controlled trials evaluating treatments for endometriosis have reported many different outcomes and outcome measures. This variation restricts effective data synthesis limiting the usefulness of research to inform clinical practice. To address these methodological concerns, we aim to develop, disseminate and implement a core outcome set for endometriosis engaging with key stakeholders, including healthcare professionals, researchers and women with endometriosis. METHODS AND ANALYSIS: An international steering group has been established, including healthcare professionals, researchers and patient representatives. Potential outcomes identified from a systematic review of the literature will be entered into a modified Delphi method. Key stakeholders will be invited to participate including healthcare professionals, researchers and women with endometriosis. Participants will be invited to score individual outcomes on a nine-point Likert scale anchored between 1 (not important) and 9 (critical). Repeated reflection and rescoring should promote whole and individual stakeholder group converge towards consensus, 'core', outcomes. High-quality outcome measures will be associated with core outcomes. ETHICS AND DISSEMINATION: The implementation of a core outcome set for endometriosis within future clinical trials, systematic reviews and clinical guidelines will enhance the availability of comparable data to facilitate evidence-based patient care. This study was prospectively registered with Core Outcome Measures in Effectiveness Trials Initiative; number: 691.

20 Article Association between chronic pelvic pain symptoms and the presence of endometriosis. 2016

Apostolopoulos, Nikolaos V / Alexandraki, Krystallenia I / Gorry, Anwen / Coker, Adeyemi. ·Department of Obstetrics and Gynaecology, Queen's Hospital, Rom Valley Way, Romford, RM70AG, UK. napostol@doctors.org.uk. · Department of Endocrinology, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK. · Department of Obstetrics and Gynaecology, Queen's Hospital, Rom Valley Way, Romford, RM70AG, UK. ·Arch Gynecol Obstet · Pubmed #26329801.

ABSTRACT: PURPOSE: The link between endometriosis and the presence or intensity of pain is controversial. The aim of the present study was to assess the relationship between chronic pelvic pain (CPP) and severity of endometriosis and the effectiveness of laparoscopic treatment in a 6-month follow-up. METHODS: Prospective observational study in a referral unit. 144 women had laparoscopy to investigate CPP. Symptoms were assessed by a 10-point visual analog scale. The main outcome measure was the frequency and intensity of CPP. RESULTS: No difference in pain was found between women with and without endometriosis. Advanced endometriosis was associated with dysmenorrhea, deep endometriosis with dyspareunia and rectovaginal disease with dyschezia. Laparoscopic treatment improves symptoms. CONCLUSIONS: Women with severe endometriosis are more likely to report severe dysmenorrhoea. Furthermore location of endometriosis in the rectovaginal space is associated with dyschezia and deep endometriosis with dyspareunia. However, the association between presence and stage of endometriosis and severity of symptoms is marginal.

21 Article Galectin-1 overexpression in endometriosis and its regulation by neuropeptides (CRH, UCN) indicating its important role in reproduction and inflammation. 2014

Vergetaki, Aikaterini / Jeschke, Udo / Vrekoussis, Thomas / Taliouri, Eirini / Sabatini, Luca / Papakonstanti, Evangelia A / Makrigiannakis, Antonis. ·Department of Obstetrics and Gynecology, Medical School, University of Crete, Heraklion, Greece. · Department of Obstetrics and Gynecology, Innenstadt campus, Ludwig Maximilians University of Munich, Munich, Germany. · Department of Obstetrics and Gynecology, Medical School, University of Ioannina, Ioannina, Greece. · Centre for Reproductive Medicine, St Bartholomew's Hospital, London, United Kingdom. · Department of Biochemistry, Medical School, University of Crete, Heraklion, Greece. ·PLoS One · Pubmed #25473847.

ABSTRACT: Endometriosis is an inflammatory disease of women of reproductive age featured by the presence of ectopic endometrium and is strongly related to infertility. Galectins, carbonhydrate-binding proteins, have been found to have pro- or anti-inflammatory roles in the reproductive tract and in pathological conditions concerning infertility. Galectin-1, which is expressed at endometrium and decidua, plays a major role in implantation and trophoblast invasion. Also, the neuropeptides, corticotropin releasing hormone (CRH) and urocortin (UCN) and their receptors are expressed in eutopic and ectopic endometrium showing a differential expression pattern in endometriotic women compared to healthy ones. The aim of this study was to examine the galectin-1 expression in endometriotic lesions and compare its expression in eutopic endometrium of endometriotic and healthy women. Furthermore, we examined the effect of CRH and UCN in galectin-1 expression in Ishikawa cell line and macrophages and investigated the implication of CRHR1 in these responses. Eutopic and ectopic endometrium specimens, Ishikawa cell line and mice macrophages were used. Immunohistochemistry and western blot analysis were performed in order to identify galectin-1 expression in ectopic and eutopic endometrium of women with and without endometriosis and the regulatory effect of CRH and UCN on galectin-1 expression. This study presents for the first time that galectin-1 is overexpressed in endometriotic lesions compared to eutopic endometrium of endometriotic women and is more abundantly expressed in eutopic endometrium of disease women compared to healthy ones. Furthermore, it is shown that CRH and UCN upregulate galectin-1 expression in Ishikawa cell line and macrophages and this effect is mediated through CRHR1. These results suggest that galectin-1 might play an important role in endometriosis pathology and infertility profile of women suffering from endometriosis by being at the same time regulated by CRH and UCN interfering in the immune disequilibrium which characterizes this pathological condition.

22 Article Endometriosis: a rare cause of small bowel obstruction. 2012

Khwaja, Samir A / Zakaria, Rasheed / Carneiro, Herman Anthony / Khwaja, Haris A. ·Royal London Hospital, London, UK. ·BMJ Case Rep · Pubmed #22891009.

ABSTRACT: Although endometriosis is a common condition in young women, symptomatic involvement of the small bowel is rare. The authors report the case of a 44-year-old lady initially thought to have irritable bowel syndrome who presented 1 month later with acute small bowel obstruction. A CT scan showed small bowel dilatation with a transition point in the ileum, but no distinct lesion. The patient had an exploratory laparotomy where an obstructing lesion in the terminal ileum and several enlarged mesenteric lymph nodes were identified. Consequently, a right hemicolectomy was performed. Pathology specimens showed multiple endometriotic foci in the bowel with stricturing of terminal ileum and appendiceal intussusception. This likely resulted in subocclusive episodes and intestinal obstruction. This case highlights the difficulty in establishing a preoperative diagnosis of endometriosis. Small bowel endometriosis should, therefore, be considered in the differential diagnosis of women of childbearing age who present with symptoms of obstruction.

23 Minor Author's Reply. 2018

Pundir, Jyotsna / Kovoor, Elias / Lancaster, Gillian / Smith, Peter Barton. ·Centre for Reproductive Medicine, St. Bartholomew's Hospital, West Smithfield, London, UK. · Maidstone and Tunbridge Wells NHS Trust, Kent, UK. · Professor of Medical Statistics, Institute of Primary Care and Health Sciences, Keele University, Keele, Newcastle, UK. · Princess Grace Hospital, London, UK. ·J Minim Invasive Gynecol · Pubmed #29180310.

ABSTRACT: -- No abstract --

24 Unspecified Perforated endometrial appendicitis in pregnancy. 2012

Giorgakis, E / Karydakis, V / Farghaly, A. ·Royal London Hospital , Barts and The London NHS Trust, London, UK. ·Hippokratia · Pubmed #23935277.

ABSTRACT: BACKGROUND: Endometriosis is a common disorder in women of reproductive age. A rare localization is the appendix, which, in most cases, is an incidental finding during appendectomies. The incidence of symptomatic appendiceal endometriosis or endometrial appendicitis might be increased in pregnancy. Moreover, endometrial appendicitis in pregnancy is more likely to present in an advanced stage, given the physiologic changes characterizing the gravid abdomen. MATERIALS AND METHODS: Description of a case of a pregnant woman presenting to the A&E with acute peritonitis attributable to advanced appendicitis. She underwent emergency laparotomy with appendectomy. The biopsy specimen was examined by the pathology laboratory of the same hospital. RESULTS: The laparotomy revealed perforated appendicitis. The histopathology report described acute endometrial appendicitis.