title: A systematic review of ultrasonography-guided transvaginal aspiration of recurrent ovarian endometrioma.
abstract: BACKGROUND
  Ovarian endometriosis is present in 17%-44% of women with endometriosis. The main treatment is surgery, but ultrasonography-guided aspiration is a less invasive alternative.
  
  
  OBJECTIVE
  To evaluate the effectiveness of this alternative treatment in recurrent ovarian endometrioma.
  
  
  METHODS
  Multiple databases were searched for articles published between 1994 and 2014 using the keywords "ultrasound-guided aspiration," "ovarian," and "endometriosis."
  
  
  METHODS
  Randomized controlled trials and observational studies published in English, Portuguese, or Spanish were included.
  
  
  METHODS
  Two researchers independently extracted and reviewed the data. The main outcome of interest was the recurrence rate.
  
  
  RESULTS
  Eight studies were eligible. Ovarian endometriosis is associated with high recurrence rates after one ultrasonography-guided aspiration (28.9%-91.5%), but involves less ovarian manipulation. The results of aspiration followed by sclerotherapy are not uniform, but overall the addition of a sclerosing agent does not seem to significantly reduce the likelihood of recurrence (13.3%-75.0%). Repeated aspiration of the cysts can reduce the recurrence rate to 5.4% by the sixth aspiration.
  
  
  CONCLUSIONS
  Repeated ultrasonography-guided aspiration of ovarian endometriomas can be performed for the treatment of recurrent ovarian endometriosis. Further studies comparing the efficacy of this procedure and ovarian surgery are needed.
authors.affiliation: University of Santo Amaro School of Medicine, São Paulo, Brazil.
authors.forename: Fernanda C
authors.initials: FC
authors.lastname: Gonçalves
authors.affiliation: Department of Obstetrics and Gynecology, University of São Paulo School of Medicine, São Paulo, Brazil. Electronic address: marina.dpandres@gmail.com.
authors.forename: Marina P
authors.initials: MP
authors.lastname: Andres
authors.affiliation: Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA.
authors.forename: Leigh J
authors.initials: LJ
authors.lastname: Passman
authors.affiliation: RDO Medical Diagnosis, São Paulo, Brazil.
authors.forename: Manoel O C
authors.initials: MO
authors.lastname: Gonçalves
authors.affiliation: Department of Obstetrics and Gynecology, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Sergio
authors.initials: S
authors.lastname: Podgaec
mesh_terms: D004715:Endometriosis / Q000628:therapy*; D000431:Ethanol / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D064887:Observational Studies as Topic; D010048:Ovarian Cysts / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D015911:Sclerotherapy; D013752:Tetracycline / Q000627:therapeutic use; D018084:Ultrasonography, Interventional
chemical_list: D000431:Ethanol; D013752:Tetracycline; D008727:Methotrexate
keywords: Ovarian endometriosis; Treatment; Ultrasonography-guided aspiration