Ethanol Sclerotherapy versus Laparoscopic Surgery for Endometrioma Treatment. A Prospective, Multicenter, Cohort Pilot Study.

ABSTRACT Study Objective To compare the cost-effectiveness of ultrasound (US)-guided aspiration and ethanol sclerotherapy versus laparoscopic surgery for benign-appearing ovarian endometrioma. Design A prospective, cohort pilot study. Setting Multiple centers, Spain. Patients Forty patients with suspected ovarian endometrioma identified by ultrasound, with maximum diameter 35 to 100 mm, of which 33 met inclusion criteria. Interventions The study group (n=17) underwent US-guided aspiration plus sclerotherapy with ethanol and the control group (n=14) underwent laparoscopic cystectomy. Measurements and Main Results Recurrence, complications, and direct costs were compared. One of 17 sclerotherapy patients recurred (5.9%) compared with 4 of 14 laparoscopic surgery patients (28.6%) (OR 0.18 [0.01-1.53]). No serious adverse effects (Clavien-Dindo ≥ III) were observed in the sclerotherapy group; one patient in the surgery group had a Clavien-Dindo IIIb complication. Median hospital direct costs were significantly lower in the sclerotherapy group than surgery group: 266 euros versus 2,189 euros. Conclusion Ethanol sclerotherapy seems to be cost-effective for endometrioma and appears to reduce complications as well. In this pilot study, recurrence was not higher than with conventional surgery.