A systematic review of ultrasonography-guided transvaginal aspiration of recurrent ovarian endometrioma.

Background: Ovarian endometriosis is present in 17%-44% of women with endometriosis. The main treatment is surgery, but ultrasonography-guided aspiration is a less invasive alternative.
Objectives: To evaluate the effectiveness of this alternative treatment in recurrent ovarian endometrioma.
Search Strategy: Multiple databases were searched for articles published between 1994 and 2014 using the keywords "ultrasound-guided aspiration," "ovarian," and "endometriosis."
Selection Criteria: Randomized controlled trials and observational studies published in English, Portuguese, or Spanish were included.
Data Collection and Analysis: Two researchers independently extracted and reviewed the data. The main outcome of interest was the recurrence rate.
Main Results: Eight studies were eligible. Ovarian endometriosis is associated with high recurrence rates after one ultrasonography-guided aspiration (28.9%-91.5%), but involves less ovarian manipulation. The results of aspiration followed by sclerotherapy are not uniform, but overall the addition of a sclerosing agent does not seem to significantly reduce the likelihood of recurrence (13.3%-75.0%). Repeated aspiration of the cysts can reduce the recurrence rate to 5.4% by the sixth aspiration.
Conclusions: Repeated ultrasonography-guided aspiration of ovarian endometriomas can be performed for the treatment of recurrent ovarian endometriosis. Further studies comparing the efficacy of this procedure and ovarian surgery are needed.
(Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)