The risk assessment was conducted by Tamara J Oderkerk (Maxima Medical Center, Eindhoven, The Netherlands) et al, who used the EMBASE, MEDLINE, ClincalTrials.gov and Cochrane databases to search for eligible articles from inception, to June 13, 2022 to present. To do so the investigators note that search terms included endometrial ablation and hysterectomy, and described the incidence of hysterectomy within a specific time after ablation with a minimum follow-up duration of 12 months.
Yielded from their search, the authors identified 3,022 articles, with a total of 53 studies that met their inclusion criteria. These articles consisted of six retrospective studies, 24 randomised controlled trials and 23 retrospective studies.
A total of 48,071 patients underwent endometrial ablation between 1992 and 2017, with a follow-up duration that varied between 12 and 120 months. Oderkerk et al’s analysis by follow-up found a 4.3% hysterectomy rate at 12 months (n=29 studies), 11.1% at 18 months (n=1 study), 8% at 24 months (n=11 studies), 10.2% at 36 months (n=12 studies), 7.6% at 48 months (n=2 studies), and 12.4% at 60 months (n=6 studies).
The authors state that two studies reported a mean hysterectomy rate at 10 years after ablation of 21.3%.
Concluding their review, Oderkerk and colleagues state that clinicians “can use the results of this review to counsel patients on the 12% risk of hysterectomy five years after endometrial ablation”. A statement which garnered response from Vance McCausland (George Washington University School of Medicine, Washington, USA) et al—author of the 2007 paper ‘Long-term complications of endometrial ablation’— who addressed the issue of postablation intrauterine scarring and contracture which can “obstruct persistent or regenerating endometrial tissue trapped behind the scar”.
McCausland and colleagues relay however that entering the uterus for diagnostic purposes after endometrial ablation in order to exclude carcinoma for example, “appears to be a useful diagnostic tool” within practice today. Furthermore, in their response, the authors supplement that further investigation will be required to “better understand long-term postablation problems”.