CONTROL DE DISPOSITIVOS INTRATUBARIOS ESSURE MEDIANTE ESTUDIO DE IMÁGENES

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Abstract

Objetivo: Comparar la efectividad en la detección y control del dispositivo intratubario (DIT) Essure por medio de la radiografía abdominopélvica y el ultrasonido. Método: Control de los primeros 5 casos de esterilización tubaria ambulatoria con Essure, después de 1 y 2 años de su inserción, mediante radiografía abdominopélvica y ecografía transvaginal. Resultados: Ambos exámenes de imágenes permitieron corroborar la presencia del dispositivo Essure en las 5 pacientes, al completar su primer y segundo año desde su inserción. Conclusión:Tanto la radiografía abdominopélvica como la ecografía transvaginal, permiten detectar y controlar la presencia del DIT Essure. El ultrasonido realizado por el ginecólogo en la consulta, puede reemplazar a la radiografía simple, como método de detección y control de los dispositivos intra-tubarios (Essure). Las ventajas comparativas permiten concluir que el ultrasonido, no irradia a la paciente y permite explorar el resto de la anatomía de los órganos sexuales internos durante el mismo procedimiento. Sin embargo, es de mayor costo que la radiografía

Translated abstract

Objective: To compare the effectiveness in the detection and control of Essure by pelvic radiography and ultrasound. Method: Control of the first 5 cases of ambulatory sterilization with Essure after 1 and 2 years. Detection and control by pelvic x-ray and transvaginal ultrasonography. Results: Both methods allowed corroborating the presence of the Essure device in the 5 patients, when completing their first and second year from the insertion. Conclusion: As much the pelvic x-ray as the transvaginal ultrasound allows to detect and check the presence of the Essure device. The transvaginal ultrasonography can replace the x-ray like method of detection and check of the Essure devices. The comparative advantages allow concluding that the ultrasound usually is available for the gynecologist, does not radiate the patient and allows exploring the internal sexual organs anatomy during the same act. Nevertheless, it is of greater cost than x-ray

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Most cited references 34

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The risk of pregnancy after tubal sterilization: findings from the U.S. Collaborative Review of Sterilization.

Robert J Hughes, Q. Z. Xia, J Trussell … (1996)

Our purpose was to determine the risk of pregnancy after tubal sterilization for common methods of tubal occlusion. A multicenter, prospective cohort study was conducted in U.S. medical centers. A total of 10,685 women who underwent tubal sterilization was followed up for 8 to 14 years. The risk of pregnancy was assessed by cumulative life-table probabilities and proportional hazards models. A total of 143 sterilization failures was identified. Cumulative 10-year probabilities of pregnancy were highest after clip sterilization (36.5/1000 procedures) and lowest after unipolar coagulation (7.5/1000) and postpartum partial salpingectomy (7.5/1000). The cumulative risk of pregnancy was highest among women sterilized at a young age with bipolar coagulation (54.3/1000) and clip application (52.1/1000). Although tubal sterilization is highly effective, the risk of sterilization failure is higher than generally reported. The risk persists for years after the procedure and varies by method of tubal occlusion and age.

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Hysteroscopic sterilization using a micro-insert device: results of a multicentre Phase II study.

Michael Kerin, Enrique Cayuela, Bruno Herendael … (2003)

Unlike laparoscopic surgery for interval tubal sterilization, a hysteroscopic approach obviates surgical incision and requires only local anaesthesia or intravenous sedation. The safety, tolerability and efficacy of an hysteroscopically placed micro-insert device was evaluated. A cohort of 227 previously fertile women participated in this prospective international multicentre trial. Micro-inserts were placed bilaterally into the proximal Fallopian tube lumens under hysteroscopic visualization in outpatient procedures. Successful bilateral micro-insert placement was achieved in 88% of women. The majority of women reported that intraprocedural pain was less than or equal to that expected, and 90% rated tolerance of the device placement procedure as good to excellent. Most women could be discharged in an ambulatory state within 1-2 h. Adverse events occurred in 7% of the women, but none was serious. Correct device placement was confirmed in 97% of cases at 3 months. Over 24 months follow-up, 98% of study participants rated their tolerance of the micro-insert as very good to excellent. After 6015 woman-months of exposure to intercourse, no pregnancies have been recorded. Hysteroscopic sterilization resulted in rapid patient recovery without unacceptable post-procedure pain, as well as high long-term patient tolerability, satisfaction and effective permanent contraception.

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The feasibility, success and patient satisfaction associated with outpatient hysteroscopic sterilisation.

Neil R. Clark, V Kalathy, Kapuganti J. Gupta … (2007)

To determine the feasibility and patient satisfaction of female sterilisation using the Essure system in an outpatient hysteroscopy clinic without conscious sedation or general anaesthesia. Prospective cohort study. Outpatient hysteroscopy clinic in a large teaching hospital. Women undergoing outpatient hysteroscopic sterilisation using the Essure system for permanent fertility control. Demographic and procedural data were prospectively collected from 112 consecutive women undergoing outpatient hysteroscopic sterilisation without sedation or general anaesthesia. A hysterosalpingogram (HSG) was performed routinely in all women 3 months after the procedure to confirm bilateral tubal occlusion. Postal questionnaires were sent at this time enquiring about patient satisfaction and experience with the outpatient procedure. Multivariable logistic regression was used to identify factors independently predictive of successful completion of the procedure. Technical feasibility, predictive factors for technical success (operator, body mass index, uterine size, axis, menstrual phase and cervical stenosis), complications, tubal occlusion on HSG, patient satisfaction and procedure-related experience. Successful bilateral tubal placement of the Essure microinserts was achieved in 103/112 (92%, 95% CI 85-96%) women. Nonsecretory phase of the menstrual cycle (P = 0.04) and a clinically normal-sized uterus (P = 0.003) were independently predictive for successful completion of the outpatient procedure on multivariable modelling. There were no major procedure-related complications recorded, but transient vasovagal reactions occurred in 5/112 (5%) women. Of the original cohort of 112 women with successful procedures, 84 women were 3 months postprocedure and had undergone a HSG. Bilateral tubal occlusion was confirmed in 83/84 (99%, 95% CI 94-100%) women at 3 months and in 100% at 6 months. Seventy-six of 84 (91%) had returned the questionnaires, and 70/73 (96%, 95% CI 88-99%) were satisfied with their overall experience of the procedure including radiological follow up, with most reporting being 'very satisfied' (64/73, 88%, 95% CI 78-94%). Outpatient hysteroscopic sterilisation using the Essure system without sedation or general anaesthesia is a successful and safe procedure associated with high rates of patient satisfaction. If practical, women should be scheduled to have their procedures in the proliferative phase of the menstrual cycle to optimise successful placement of Essure devices, especially if the uterus is clinically enlarged.

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Author and article information

Journal

Journal ID (publisher-id): rchog

Title: Revista chilena de obstetricia y ginecología

Abbreviated Title: Rev. chil. obstet. ginecol.

Publisher: Sociedad Chilena de Obstetricia y Ginecología (Santiago, , Chile )

ISSN (Print): 0048-766X

ISSN (Electronic): 0717-7526

Publication date (Print and electronic): 2007

Volume: 72

Issue: 6

Pages: 397-401

Affiliations

[01] orgnameClínica Las Condes orgdiv1Departamento de Obstetricia y Ginecología orgdiv2Unidad de Ginecología Chile

[02] orgnameClínica Las Condes orgdiv1Departamento de Obstetricia y Ginecología orgdiv2Programa de Ultrasonografía Ginecológica Chile

Article

Publisher ID: S0717-75262007000600007 Publisher ID: S0717-7526(07)07200607

DOI: 10.4067/S0717-75262007000600007

SO-VID: 447dcdb2-6ed1-4786-8b87-0165a0608033

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This work is licensed under a Creative Commons Attribution 4.0 International License.

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Figures: 0, Tables: 0, Equations: 0, References: 22, Pages: 5

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