Randomised trial of excision vs. ablation for electrosurgical treatment of mild (r-AFS 1–2) endometriosis

Design: Prospective, randomised study with blinding of both participant and observer at the 6-month follow-up assessment. Setting: Tertiary Referral Specialist Pelvic Pain Clinic based in a local District General Hospital. Participants: Women presenting with chronic pelvic pain Method: Participants completed a questionnaire detailing symptoms relating to chronic pelvic pain, rating them on a ranked ordinal scale. Signs elicited during pelvic examination were similarly ranked. At laparoscopy if a diagnosis of superficial mild endometriosis (rAFS 1–2) was confirmed, but there was no nodular or infiltrating disease, they were randomised and either excision or ablation of any endometriotic lesions was performed. A follow up was performed at 6 months for re-evaluation using the same rank ordinal scale. Both patient and observer were blinded. Results: During the study period, patients were recruited with 24 meeting the entry criteria at time of laparoscopy. Both treatment modalities produced equally statistically significant improvements in symptoms and signs, with 92% (22 out of 24) stating an improvement at 6 months. There was also no difference in morbidity and one woman in each group became pregnant during the study period. Discussion: This small study showed that at 6 months there was good symptom relief from pelvic pain for the majority of participants irrespective of the treatment modality in women with mild, superficial disease. If disease is mild and superficial, treatment can be carried out by appropriately trained generalist gynaecologists. Nodular or infiltrating disease should be referred to specialist centres for treatment. Predictors of appreciable improvement were high pain scores prior to treatment.