COGI 2013- Abstract submission

Gynecology

COGI13-ABS-1228 TREATMENT OF PREMALIGNANT PROLIFERATIVE ENDOMETRIAL PATHOLOGY WITH A FRAMELESS LNG-IUS. LONG-TERM RESULT OF A PILOT STUDY.

Dirk R.G. Janssens Gynaecologische Dienst, Turnhout, Belgium Problem statement: The prevention of endometrial carcinoma by long-term treatment of selected patients with levonorgestrel (LNG) releasing intrauterine systems (IUS) remains rather experimental, especially when cellular atypia has been found in the endometrial biopsy specimen. We present the long-term result of a pilot study, conducted in a provincial outpatient gynaecological centre, started in 2001 and finished ten years later, by adding (only) one such case.

Methods: Out of a consecutive series of 72 patients submitted to diagnostic hysteroscopy and uterine curettage, endometrial hyperplasia was diagnosed in 13 patients, 11 of them showing ‘simple hyperplasia‘(SH), 1 case of ‘complex non-atypical hyperplasia’(CNAH) and 1 case of ‘atypical complex hyperplasia'(ACH). Benign endometrial polyps were found in 23 patients. These 36 patients were treated by the insertion of an experimental type of LNG-IUS, the FibroPlant R (Contrel Research, Belgium), aiming at preventing recurrence or worsening of endometrial pathology, and followed regularly avoiding mutilating hysterectomy as much as possible.

Results: In the patient with CNAH the LNG-IUS was removed after three years (end of trial). No bleeding or sign of endometrial pathology was observed during further follow-up for five years. The patient with ACH was followed-up till present for almost 12 years after the first LNG-IUS, which since then has been renewed twice. No endometrial pathology was detected during follow-up. Hysterectomy was eventually performed in only 3 patients, one with SH and two with benign polyps.

Conclusion: Treatment of benign or premalignant endometrial proliferation with a LNG-IUS limited the incidence of hysterectomy to less than 10%. Our personal experience, summarizing one decade of clinical investigation, is limited but the results are encouraging and indicate that a large-scale and multicentre evaluation of this therapeutic option is warranted.

Disclosure of Interest: None Declared