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Chapter 10 - Hysteroscopic Endometrial Polypectomy

Published online by Cambridge University Press:  10 September 2020

Mary E. Connor
Affiliation:
Royal Hallamshire Hospital, Sheffield
T. Justin Clark
Affiliation:
Birmingham Women’s Hospital
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Summary

Endometrial polyps are localised overgrowths of endometrial tissue that can occur anywhere in the uterine cavity. They contain variable amounts of glands, stroma and blood vessels that are covered by a layer of endometrium. Most commonly they are attached to the uterus by an elongated pedicle (pedunculated), but they may also have a large flat base (sessile). They range in size from a few millimetres to several centimetres (Figure 10.1).

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Publisher: Cambridge University Press
Print publication year: 2020

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References

Clark, TJ, Gupta, JK. Handbook of Outpatient Hysteroscopy: A Complete Guide to Diagnosis and Therapy. London: Hodder Arnold; 2005.Google Scholar
Dreisler, E, Stampe Sorensen, S, Ibsen, PH, Lose, G. Prevalence of endometrial polyps and abnormal uterine bleeding in a Danish population aged 20–74 years. Ultrasound Obstet Gynecol 2009; 33: 102–8.CrossRefGoogle Scholar
Fay, TN, Khanem, N, Hosking, D. Out-patient hysteroscopy in asymptomatic postmenopausal women. Climacteric J Int Menopause Soc 1999; 2: 263–7.Google Scholar
Fatemi, HM, Kasius, JC, Timmermans, A, et al. Prevalence of unsuspected uterine cavity abnormalities diagnosed by office hysteroscopy prior to in vitro fertilization. Hum Reprod 2010; 25: 1959–65.CrossRefGoogle ScholarPubMed
de Ziegler, D. Contrast ultrasound: a simple-to-use phase-shifting medium offers saline infusion sonography-like images. Fertil Steril 2009; 92: 369–73.Google Scholar
Bakour, SH, Khan, KS, Gupta, JK The risk of premalignant and malignant pathology in endometrial polyps. Acta Obstet Gynecol Scand 2002; 81: 182–3.CrossRefGoogle ScholarPubMed
Clevenger-Hoeft, M, Syrop, CH, Stovall, DW, Van Voorhis, BJ. Sonohysterography in premenopausal women with and without abnormal bleeding. Obstet Gynecol 1999; 94: 516–20.Google ScholarPubMed
Elfayomy, AK, Habib, FA, Alkabalawy, MA. Role of hysteroscopy in the detection of endometrial pathologies in women presenting with postmenopausal bleeding and thickened endometrium. Arch Gynecol Obstet 2012; 285: 839–43.Google Scholar
Reslová, T, Tosner, J, Resl, M, Kugler, R, Vávrová, I. Endometrial polyps: a clinical study of 245 cases. Arch Gynecol Obstet 1999; 262: 133–9.Google ScholarPubMed
Perrone, G, DeAngelis, C, Critelli, C, et al. Hysteroscopic findings in postmenopausal abnormal uterine bleeding: a comparison between HRT users and non-users. Maturitas 2002; 43: 251–5.Google Scholar
Maia, H, Maltez, A, Studard, E, Athayde, C, Coutinho, EM. Effect of previous hormone replacement therapy on endometrial polyps during menopause. Gynecol Endocrinol 2004; 18: 299304.Google Scholar
McGurgan, P, Taylor, LJ, Duffy, SR, O’Donovan, PJ. Are endometrial polyps from pre-menopausal women similar to post-menopausal women? An immunohistochemical comparison of endometrial polyps from pre- and post-menopausal women. Maturitas 2006; 54: 277–84.Google Scholar
Taylor, LJ, Jackson, TL, Reid, JG, Duffy, SRG. The differential expression of oestrogen receptors, progesterone receptors, Bcl-2 and Ki67 in endometrial polyps. BJOG 2003; 110: 794–8.Google Scholar
La Torre, R, De Felice, C, De Angelis, C, et al. Transvaginal sonographic evaluation of endometrial polyps: a comparison with two dimensional and three dimensional contrast sonography. Clin Exp Obstet Gynecol 1999; 26: 171–3.Google Scholar
Nieuwenhuis, LL, Hermans, FJ, Bij de Vaate, AJM, et al. Three-dimensional saline infusion sonography compared to two-dimensional saline infusion sonography for the diagnosis of focal intracavitary lesions. Cochrane Database Syst Rev 2017; (5): CD011126.Google ScholarPubMed
Gimpelson, RJ, Rappold, HO. A comparative study between panoramic hysteroscopy with directed biopsies and dilatation and curettage: a review of 276 cases. Am J Obstet Gynecol 1988; 158: 489–92.Google Scholar
van Hanegem, N, Breijer, MC, Slockers, SA, et al. Diagnostic workup for postmenopausal bleeding: a randomised controlled trial. BJOG 2017; 124: 231–40.Google ScholarPubMed
Birinyi, L, Daragó, P, Török, P, et al. Predictive value of hysteroscopic examination in intrauterine abnormalities. Eur J Obstet Gynecol Reprod Biol 2004; 115: 75–9.Google Scholar
Savelli, L, De Iaco, P, Santini, D, et al. Histopathologic features and risk factors for benignity, hyperplasia, and cancer in endometrial polyps. Am J Obstet Gynecol 2003; 188: 927–31.CrossRefGoogle ScholarPubMed
Antunes, A, Costa-Paiva, L, Arthuso, M, Costa, JV, Pinto-Neto, AM. Endometrial polyps in pre- and postmenopausal women: factors associated with malignancy. Maturitas 2007; 57: 415–21.Google Scholar
Gregoriou, O, Konidaris, S, Vrachnis, N, et al. Clinical parameters linked with malignancy in endometrial polyps. Climacteric J Int Menopause Soc 2009; 12: 454–8.Google Scholar
Wang, JH, Zhao, J, Lin, J. Opportunities and risk factors for premalignant and malignant transformation of endometrial polyps: management strategies. J Minim Invasive Gynecol 2010; 17: 53–8.Google Scholar
Ferrazzi, E, Zupi, E, Leone, FP, et al. How often are endometrial polyps malignant in asymptomatic postmenopausal women? A multicenter study. Am J Obstet Gynecol 2009; 200: 235.e16.Google Scholar
Lieng, M, Istre, O, Qvigstad, E. Treatment of endometrial polyps: a systematic review. Acta Obstet Gynecol Scand 2010; 89: 9921002.Google Scholar
Timmermans, A, Opmeer, BC, Veersema, S, Mol, BWJ. Patients’ preferences in the evaluation of postmenopausal bleeding. BJOG 2007; 114: 1146–9.Google Scholar
DeWaay, DJ, Syrop, CH, Nygaard, IE, Davis, WA, Van Voorhis, BJ Natural history of uterine polyps and leiomyomata. Obstet Gynecol 2002; 100(1): 37.Google Scholar
Cohen, I. Endometrial pathologies associated with postmenopausal tamoxifen treatment. Gynecol Oncol 2004; 94: 256–66.Google Scholar
Kedar, RP, Bourne, TH, Powles, TJ, et al. Effects of tamoxifen on uterus and ovaries of postmenopausal women in a randomised breast cancer prevention trial. Lancet 1994; 343: 1318–21.CrossRefGoogle Scholar
Dueholm, M, Hjorth, IMD, Secher, P, Jørgensen, A, Ørtoft, G. Structured hysteroscopic evaluation of endometrium in women with postmenopausal bleeding. J Minim Invasive Gynecol 2015; 22: 1215–24.Google Scholar
Munro, MG, Critchley, HOD, Fraser, IS. The FIGO systems for nomenclature and classification of causes of abnormal uterine bleeding in the reproductive years: who needs them? Am J Obstet Gynecol 2012; 207: 259–65.CrossRefGoogle Scholar
Mittal, K, Schwartz, L, Goswami, S, Demopoulos, R. Estrogen and progesterone receptor expression in endometrial polyps. Int J Gynecol Pathol 1996; 15: 345–8.Google Scholar
Thijs, I, Neven, P, Van Hooff, I, et al. Oestrogen and progesterone receptor expression in postmenopausal endometrial polyps and their surrounding endometrium. Eur J Cancer 2000; 36(Suppl 4): 108–9.Google Scholar
Pérez-Medina, T, Bajo-Arenas, J, Salazar, F, et al. Endometrial polyps and their implication in the pregnancy rates of patients undergoing intrauterine insemination: a prospective, randomized study. Hum Reprod 2005; 20: 1632–5.Google Scholar
Smit, JG, Kasius, JC, Eijkemans, MJC, et al. Hysteroscopy before in-vitro fertilisation (inualiSIGHT): a multicentre, randomised controlled trial. Lancet 2016; 387: 2622–9.CrossRefGoogle ScholarPubMed
El-Toukhy, T, Campo, R, Khalaf, Y, et al. Hysteroscopy in recurrent in-vitro fertilisation failure (TROPHY): a multicentre, randomised controlled trial. Lancet 2016; 387: 2614–21.CrossRefGoogle ScholarPubMed
Timmermans, A, Veersema, S, van Kerkvoorde, TC, et al. Should endometrial polyps be removed in patients with postmenopausal bleeding? An assessment of study designs and report of a failed randomised controlled trial (ISRCTN73825127). BJOG 2009; 116: 1391–5.Google Scholar
Lieng, M, Istre, O, Sandvik, L, Engh, V, Qvigstad, E. Clinical effectiveness of transcervical polyp resection in women with endometrial polyps: randomized controlled trial. J Minim Invasive Gynecol 2010; 17: 351–7.Google Scholar
Haimov-Kochman, R, Deri-Hasid, R, Hamani, Y, Voss, E. The natural course of endometrial polyps: could they vanish when left untreated? Fertil Steril 2009; 92: 828.e11–2.Google Scholar
National Institute for Health and Care Excellence. Heavy Menstrual Bleeding: Assessment and Management. NICE Guideline NG88. London: NICE; 2018. www.nice.org.uk/guidance/ng88 (accessed November 2019).Google Scholar
Gardner, FJE, Konje, JC, Bell, SC, et al. Prevention of tamoxifen induced endometrial polyps using a levonorgestrel releasing intrauterine system long-term follow-up of a randomised control trial. Gynecol Oncol 2009; 114: 452–6.Google Scholar
Vercellini, P, Trespidi, L, Bramante, T, et al. Gonadotropin releasing hormone agonist treatment before hysteroscopic endometrial resection. Int J Gynaecol Obstet 1994; 45: 235–9.CrossRefGoogle ScholarPubMed
Timmermans, A, van Dongen, H, Mol, BW, Veersema, S, Jansen, FW. Hysteroscopy and removal of endometrial polyps: a Dutch survey. Eur J Obstet Gynecol Reprod Biol 2008; 138: 76–9.Google Scholar
van Dijk, LJEW, Breijer, MC, Veersema, S, Mol, BWJ, Timmermans, A. Current practice in the removal of benign endometrial polyps: a Dutch survey. Gynecol Surg 2012; 9: 163–8.Google Scholar
Cooper, NAM, Clark, TJ, Middleton, L, et al. Outpatient versus inpatient uterine polyp treatment for abnormal uterine bleeding: randomised controlled non-inferiority study. BMJ 2015; 350: h1398.Google Scholar
Timmermans, A, Veersema, S. Ambulatory transcervical resection of polyps with the Duckbill polyp snare: a modality for treatment of endometrial polyps. J Minim Invasive Gynecol 2005; 12: 37–9.CrossRefGoogle ScholarPubMed
Tsuchiya, A, Komatsu, Y, Matsuyama, R, et al. Intraoperative and postoperative clinical evaluation of the hysteroscopic morcellator system for endometrial polypectomy: a prospective, randomized, single-blind, parallel group comparison study. Gynecol Minim Invasive Ther 2018; 7: 1621.CrossRefGoogle ScholarPubMed
Smith, PP, Middleton, LJ, Connor, M, Clark, TJ. Hysteroscopic morcellation compared with electrical resection of endometrial polyps: a randomized controlled trial. Obstet Gynecol 2014; 123: 745–51.Google Scholar
Cooper, NAM, Middleton, L, Smith, P, et al. A patient-preference cohort study of office versus inpatient uterine polyp treatment for abnormal uterine bleeding. Gynecol Surg 2016; 13: 313–22.CrossRefGoogle ScholarPubMed
Smith, PP, Kolhe, S, O’Connor, S, Clark, TJ. Vaginoscopy Against Standard Treatment (VAST): a randomised controlled trial. BJOG 2019; 126: 891–9.Google Scholar
Bettocchi, S, Ceci, O, Di Venere, R, et al. Advanced operative office hysteroscopy without anaesthesia: analysis of 501 cases treated with a 5 Fr. bipolar electrode.Hum Reprod 2002; 17: 2435–8.Google Scholar

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