New Non-Surgical Endo Diagnosis Test?

There is much talk circulating about a recent development of a non-surgical diagnostic test for endometriosis.  Currently, the only definitively way to diagnosis endometriosis is to perform a laparoscopy, a surgery performed by keyhole incisions which allow the surgeon to insert various instrument into the pelvis and abdomen while the patient is under general anaesthesia. While considered invasive but still simple to most gynaecologist’s who perform these operations, this operation requires the patient to undergo an awful pre-surgical prep process, to fast before surgery, undergo the risks associated with anaesthetic and the risks associated with the carbon dioxide that is pumped into their system to inflate their abdomen. There is also the additional risk of having the surgical instruments inside their pelvic and abdominal cavities. Waivers for this procedure sound familiar to most other surgeries (loss of life, etc.), but include a clause such as puncture to an organ from an instrument.

So, with millions of women suffering from the pains of endometriosis and eventually undergoing a laparoscopy for diagnosis, one would like a non-surgical way to skip the O.R. completely, right? For years doctors have struggled to give “probable diagnoses” with techniques such as the MRI and ultrasound, but we know these things are inadequate as they are not a definitive diagnoses. They do not allow endometrisios patients access to specific endometriosis meds with some of their insurance providers, and most importantly, peace of mind knowing what is it they’ve been struggling with for X amount of years.

Now it appears that researchers in Belguim, Jordan and Australia were thinking along the same lines. They set out to find a simple way to identify women with endometriosis without having to perform a laparascopy. The women who have endometriosis can then be operated on and their endometriosis removed. For women without endometriosis, this means not getting adhesions from a needless surgery.

But, how does this simple non-surgical test work?

Now researchers at the University of Sydney and Mu’tah University in Karak, Jordan, have discovered that if they take a small sample of the endometrium (the lining of the uterus), which can be done by inserting the device for taking the biopsy via the vagina, and then test for the presence of nerve fibres in the sample, they can diagnose whether or not endometriosis is present with nearly 100% accuracy.

They enter via the vagina, as if doing a simple pap smear, take the biopsy and in a few days the results come in. According to Dr. Al-Jefout, one of the researchers, the results look very promising.

Dr Al-Jefout said: “This study has shown that testing for nerve fibres in endometrial biopsies is a valid and highly accurate diagnostic test for endometriosis. This test is probably as accurate as assessment via laparoscopy, the current gold standard, especially as it is unclear how often endometriosis is overlooked, even by experienced gynaecologists. Endometrial biopsy is clearly less invasive than laparoscopy, and this test could help to reduce the current lengthy delay in diagnosis of the condition, as well as allowing more effective planning for formal surgical or long-term medical management. It may be particularly helpful in cases of infertility.”

“It needs to be emphasised that this test requires a carefully collected endometrial biopsy and an experienced immunohistochemical pathology laboratory to confirm or exclude the presence of nerve fibres.”He continued: “Our results indicate that a negative endometrial biopsy result would miss endometriosis in only one percent of women. Performing a planned laparoscopy only on a woman with a positive endometrial biopsy result would result in endometriosis being confirmed in eighty to ninety percent of these women. Thus, using this diagnostic test in an infertility workup would significantly reduce the number of laparoscopies performed without reducing the number of women whose endometriosis is diagnosed and surgically treated.”

Currently, researchers are planning on doing a double-blind study in September 2009 (finally, researchers who know how to do researchers – I applaud you Dr Bokor and the team of Prof D’Hooghe). They will be performing this study to confirm their results. If these results are confirmed, this could mean a simpler and easier way to diagnose women with endometriosis and get them proper treatment.

You can read the full article here : At lat – a quick an accurate way of diagnosing endometriosis


7 responses to “New Non-Surgical Endo Diagnosis Test?

  1. The whole realm of minimally invasive surgery/biopsy using natural orifices for access is very promising. Most of the study results show a reduction in the complexities associated with preparation for surgery, the surgery itself and surgical recovery. By avoiding access through the external skin, the chances of infection are significantly reduced and healing time is shorter.

    From what I have seen, doctors have removed kidneys through the vagina and gall bladders and the appendix through the mouth so the technique is becoming much more common.

  2. But why are the nerve fibres there ? Is it the endo causing the pain or the nerve fibres ?

  3. Pingback: Endometriosis Test On Horizon? —

  4. I’m concerned about this new method. The nerve fibers tested may not have endo; but there may be endo present in other nerve fibers that weren’t tested. So the endo could still be there, but the woman will be told she doesn’t have endo.
    The other main concern I have is the ‘spread’ of endo. It isn’t proven that endo can spread, but I don’t like the idea of endometrial fibers (and endo cells) going down through the vaginal canal & cervix. The cells can spread to the cervix &/or vaginal cuff/area. Then the woman will have endo in those places.
    Women who have had vaginal hysterectomies report having endo in the vaginal cuff area, so it is possible for endo cells to move there.
    Endometriosis in the vaginal area is extremely complex & hard to remove, can give lifelong problems & complications.

    • Thank for your comment. Your concern is surely warranted and it’s important to note that this method of testing is still being researched. Surely this concern has come into play for the doctors involved in the trial, or at least I hope they have considered it, and they are dealing with the ramification of exposing the vaginal cuff to nerve fibers with endometriosis. But this is why this method is still being tested. If cases begin to present where it spreads it will do so in that last clinical trial stage. In all appearances, the scientists involved in this project appear to be taking their measures very slowly and methodically. They are not rushing to conclusions and do not want doctors to begin testing for endometriosis in this fashion until they can determine that is indeed a safe and effective alternative to laparoscopy in determining patients with and without endometriosis. I would be very interested in interviewing these scientist on a one-on-one basis.

    • Just to try and help.

      There are no spots of endometriosis in the nerve fibres. What the Sydney group found were nerve fibres in the endometrium (lining of the womb) – which does not usually have nerve fibres. The women had a laparoscopic diagnosis of endometriosis. So they said – perhaps if we just took a sample of the lining of the womb in the clinic using a suction curette then that might mean women would no longer need to have laparoscopy (a relatively dangerous procedure) ? Others have found these abnormal nerve fibres in the muscle of the womb, the uterosacral ligaments, the cervix, etc. The group have not studied a large group of women with chronic pelvic pain without endometriosis. Some of us believe those women will show nerve fibres in the lining of the womb. These nerves have been around since 2002

      The question is where are these abnormal nerves appearing from ? Some say injuries in childbirth, some say physical efforts during defaecation, some say other injuries to the pelvis, etc

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