title: Concomitant hysteroscopic endometrial ablation and Essure procedure: feasibility, efficacy and satisfaction.
abstract: OBJECTIVE
  Hysteroscopic endometrial destruction procedures for abnormal uterine bleeding are an alternative to hysterectomy. Such procedures are not contraceptive and are performed on fertile patients, requiring long-term contraception. This is the first study evaluating long-term results of a combined procedure associating endometrial destruction and concomitant hysteroscopic tubal sterilization by Essure(®) micro-inserts. Our goal is to evaluate efficacy of endometrial destruction as well as hysteroscopic sterilization and satisfaction after a combined procedure in the case of abnormal uterine bleeding in non-menopausal patients.
  
  
  METHODS
  This is a retrospective study (Canadian task force II-2) that includes 131 patients operated with combined endometrial destruction and hysteroscopic tubal sterilization between 2002 and 2011 at our university hospital. The patients were contacted to answer a questionnaire. Statistical analysis was performed with SAS© version 9.2. (SAS Institute Inc., Cary, NC).
  
  
  RESULTS
  Ninety-three patients out of 131 could be reached. The mean follow-up was of 37.8 months (min=8, max=87, SD=6.2). Thirty-eight patients (29%) were lost to follow-up. Essure(®) micro-inserts introduction success rate (evaluated on 131 patients) was 95.8%, and their position was appropriate in 81.1% of the 106 patients with position control. Efficacy of the procedure on the haemorrhagic symptoms (evaluated on 93 patients) was 80.6%. Twelve patients (12.9%) underwent a hysterectomy, 7 of which (58.3%) were a direct consequence of treatment failure. No pregnancies were reported. Satisfaction rate was of 90.3%.
  
  
  CONCLUSIONS
  Inadequate position rates of the micro-inserts after 3 months seem somewhat above literature findings, though no pregnancy has been reported. However, recurrent bleeding symptoms and hysterectomy rates are consistent with those observed after an endometrial destruction procedure alone. Limitations are the limited number of patients, the bias inherent to retrospective studies (lost of follow-up, selection bias). The concomitant endometrial destruction and tubal sterilization by micro-inserts is a safe and efficient procedure.
authors.affiliation: AP-HP, Hospital Bicêtre, Department of Gynaecology and Obstetric, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France. Electronic address: yael.levy.zauberman@gmail.com.
authors.forename: Y
authors.initials: Y
authors.lastname: Levy-Zauberman
authors.affiliation: AP-HP, Hospital Bicêtre, Department of Gynaecology and Obstetric, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France.
authors.forename: G
authors.initials: G
authors.lastname: Legendre
authors.affiliation: AP-HP, Hospital Bicêtre, Department of Gynaecology and Obstetric, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France.
authors.forename: A
authors.initials: A
authors.lastname: Nazac
authors.affiliation: AP-HP, Hospital Antoine Béclère, Department of Gynaecology and Obstetric, 157 rue de la Porte de Trivaux, 92140 Clamart, France.
authors.forename: E
authors.initials: E
authors.lastname: Faivre
authors.affiliation: AP-HP, Hospital Antoine Béclère, Department of Gynaecology and Obstetric, 157 rue de la Porte de Trivaux, 92140 Clamart, France; Université Paris-Sud, 63 rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France.
authors.forename: X
authors.initials: X
authors.lastname: Deffieux
authors.affiliation: AP-HP, Hospital Bicêtre, Department of Gynaecology and Obstetric, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; INSERM U1018, CESP «Reproduction et développement de l'enfant», 82 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; Université Paris-Sud, 63 rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France.
authors.forename: H
authors.initials: H
authors.lastname: Fernandez
mesh_terms: D000328:Adult; D002170:Canada; D055356:Endometrial Ablation Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D015907:Hysteroscopy / Q000379:methods*; D008796:Metrorrhagia / Q000601:surgery* / Q000628:therapy; D008875:Middle Aged; D017060:Patient Satisfaction; D017697:Premenopause; D012189:Retrospective Studies; D013246:Sterilization, Tubal / Q000379:methods*; D017211:Treatment Failure
keywords: Abnormal uterine bleeding; Endometrectomy; Endometrial destruction; Hysteroscopy; Tubal sterilization