Published in the Journal of Vascular and Interventional Radiology, a recent retrospective study which evaluated pain relief after percutaneous image-guided cryoablation in patients with symptomatic extraperitoneal endometriosis (EE), has found the treatment to be “safe and effective”. Lead author Francois H Cornelis (Memorial Sloan Kettering Cancer Center, New York City, USA) and colleagues detail that the minimally invasive procedure “significantly reduced pain” and succeeded in obtaining local control of EE in their patient population.
Affecting around 190 million women of reproductive age worldwide, EE is a chronic disease that many women have “limited awareness” of, the study authors state. For this reason, they believe that lengthy delays can occur between symptom onset and diagnosis. Therapeutic options most commonly offered to these patients are hormonal agents or surgical excision. However, among the minimally invasive procedures developed during the last decade, Cornelis et al explain, cryoablation has become a “promising option” for the treatment of abdominal wall EE, with “satisfactory outcomes and low morbidity”.
“Cryoablation of soft-tissue lesions may be performed safely because the ice produced remains visible using the imaging techniques used in interventional radiology [IR] to guide the procedure,” Cornelis and colleagues explain, noting the improved precision cryoablation can provide when assessing the margins of ablation, thus reducing risks.
Conducted between 2017 and 2022, theirs was an observational and retrospective study, which employed the database of a single institution identifying patients who were referred to the IR department for cryoablation of symptomatic EE. The authors delineate that diagnosis of EE was based on the results of a pathologic analysis or via the identification of clinical/radiological features of EE, such as a mass accompanied by pain that is often cyclical in its recurrence.
Cornelis and colleagues identified a total of 42 women from the database with whom had a median age of 37 years. Among this cohort, 47 lesions were treated. Patients were made aware that cryoablation is offered as a minimally invasive alternative to surgery, but that a secondary surgical resection could be performed if necessary.
The median follow-up duration was 13.5 months after cryoablation, the authors convey that the median pain-free survival rate post-procedure was 93.8% (95% confidence interval [CI], 77.3–98.4) at six months and 82.7% (95% CI, 58.8–93.5) after 12 months. Pain decreased from a median of eight out of 10 on the visual analogue scale, to zero out of 10 at last follow-up. Additionally, their results show the efficacy rate of cryoablation to avoid secondary surgery was recorded as 92.8%. Characterised by a recurrence of pain, Cornelis et al reported a 2% rate of adverse events in this cohort, noting four patients who reported pain in the days following the procedure, and one patient that reported a recurrence of symptoms a year following.
Restating the “excellent safety profile” of cryoablation seen in their results, the authors emphasise that due to the freezing procedural temperatures, the ice is visible under real-time imaging guidance, reducing the “risks of injuring the skin or bowel”. Although previously demonstrated, Cornelis and colleagues note that their findings confirm cryoablation “can be performed safely” in patients under local anaesthesia and on an outpatient basis, “reducing the length of hospitalisation and postoperative recovery”.
Moreover, Cornelis et al convey the effectiveness of cryoablation for EE in their results, but conclude that the procedure “must be evaluated in multidisciplinary committees to ensure adequate selection and follow-up of women”. They state that prospective trials must be carried out to confirm the technique so that it can be incorporated into future guidelines for the therapeutic treatment of EE.
