Hysteroscopic tubal sterilization: a systematic review of the Essure system.
OBJECTIVE
To update the evidence of the efficacy and safety of the Essure system. Female sterilization has undergone changes in the last decade. Besides laparoscopic tubal occlusion, the Essure system is now a viable option, with about 200,000 women sterilized using this method.


METHODS
The review is based on the report of the Alberta Heritage Foundation for Medical Research and completed with systematic literature searches up to April 8, 2008.


METHODS
The Managed Uptake of Medical Methods program of the Finnish National Research and Development Center for Health and Welfare.


METHODS
Women over 30 years, who had been sterilized by the Essure method.


METHODS
Hysteroscopic tubal sterilization using Essure system.


METHODS
Efficacy/effectiveness, adverse events, costs.


RESULTS
Sterilization by Essure can be performed under local anesthesia or with oral analgesics in ambulatory settings. However, sterilization is not immediate and women must use additional contraception for 3 months until permanent tubal occlusion is verified by transvaginal ultrasound, hysterosalpingosonography, hysterosalpingography, or pelvic radiography. The evidence on efficacy and safety is mainly available from short follow-up case series but shows good efficacy and safety of the Essure system. Only a few small risks are associated with the procedure. Two economic studies, one of which implemented Essure as an in-office procedure, suggest that Essure could be more cost-effective than laparoscopic sterilization, but more information on the total cost is needed.


CONCLUSIONS
The Essure system appears to be safe, permanent, irreversible, and a less invasive method of contraception compared with laparoscopic sterilization.
Hurskainen
Ritva
R
Department of Obstetrics and Gynecology, Hyvinkää Hospital, Hyvinkää, Finland. ritva.hurskainen@hus.fi
Hovi
Sirpa-Liisa
SL
Gissler
Mika
M
Grahn
Riitta
R
Kukkonen-Harjula
Katriina
K
Nord-Saari
Merja
M
Mäkelä
Marjukka
M
D000818:Animals; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects / Q000379:methods*; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D013246:Sterilization, Tubal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*