J. Sroussi, M. Mezzadri, AS. Chevalier, A. Fazel, Y. Delpech, JL. Benifla Service de Gynécologie-Obstétrique, Hôpital Lariboisière,
2 rue Ambroise Paré, 75010 Paris.
Endometrial thermablation French experience
1er Congrès SEUD Paris, 7-9 mai 2015
Menorrhagia diagnosis Subjective criteria
- 20 to 30% of women - 30% with menorrhagia (> 80 mL) consider their menstruation as normal - 20% with menstrual bleeding (< 20 mL) consider their menstrutation as abnormal - Higham score PC Reid et al., 2000
Menorrhagia management Unresponsive to medical treatment
Unresponsive Not tolerated
2nd Line
1st Line Medical Treatment
Surgical Treatment
Hysterectomy Conservative
1st generation Hysteroscopic
Endometrial resection
2nd generation Endometrial
thermablation
Menorrhagia management Conservative management
Resection Thermablation Thermachoice Thermablate Cavaterm
Radiofrequence Novasure
Menorrhagia management Conservative management
Brun JL. et al., 2006
Resection vs Thermablation Multicenter randomized study 51 women
Menorrhagia management Endometrial Thermablation
Cavaterm* Review 2000 – 2006
75 to 90 %
Success rate
Menorrhagia management UK recommandations
PC Reid et al., 2005
• Technology Appraisal, 2004 • Clinical Guideline, 2007 • Reference guide, 2007 • Annual Evidence, Update 2009
! Second-generation EA techniques (G2) are simpler, quicker and more effective compared with first-generation (G1) and hysterectomy.
! G2 techniques are less operator-dependent than G1
techniques, ! The Cavaterm model estimated that TBEA* is cost saving when
compared with hysterectomy or other EA techniques.
National Institute for Clinical Excellence
COLLÈGE NATIONAL DES GYNÉCOLOGUES ET OBSTÉTRICIENS FRANÇAIS Mise à jour en Gynécologie et obstétrique (2008)
« Pour les femmes n’ayant plus de désir de conception, et en cas d’échec des traitements médicaux tels qu’ils viennent d’être définis, il faut proposer des techniques de 2e génération de destruction d’endomètre qui sont les plus efficaces compte tenu de leur reproductibilité et de leur efficacité. »
Menorrhagia management French recommandations
Endometrial thermablation French experience
- Internet Survey (Medical Gynecologist)
- PMSI data collection (CCAM) JKNE001 Endometrial resection JKND001 Thermablation
Transfered by a general practician
Came by their own 20 %
Healthcare Market Research, 2014
Endometrial thermablation French medical gynecologist survey
Hysterectomy Endometrial resection
Radiofrequence Thermablation
Healthcare Market Research, 2014
Endometrial thermablation French medical gynecologist survey
Endometrial thermablation PMSI French Data collection
2008 - 2012
22 124 23 857 25 555 26 928 28 649
1 357 1 996 2 335 2 632 2 960
23 516 25 929
28 030 29 739 31 798
0
5 000
10 000
15 000
20 000
25 000
30 000
35 000
2008 2009 2010 2011 2012
Nom
bre
de s
éjou
rs
1ère génération (JKNE001)
2ème génération (JKND001)
35 % 29 %
118 %
Endometrial thermablation PMSI French Data collection
2008 - 2012
3 years Follow up Women > 40 years
Endometrial Thermablation PMSI French Data collection
2008 - 2012 Re-hospitalisation
Endometrial Thermablation PMSI French Data collection
2008 - 2012 Hysterectomy rate
Menorrhagia management Conservative management
Fergusson RJ. et al., Cochrane database, 2013
2007-2013 Improvement of Bleeding
2007-2013 Quality of life, 1 2 and 4 years
Menorrhagia management Conservative management
Fergusson RJ. et al., Cochrane database, 2013
2007-2013 Adverse events
2007-2013 Time to retur to work
Time to retur to normal activity
Menorrhagia management Conservative management
Bansi-Matharu L. et al., 2013
British retrospective study National Database 2000 - 2011 114 910 women
85 % Success rate
Menorrhagia management Conservative management
Bansi-Matharu L. et al., 2013
80 %
2nd Look Success rate
Menorrhagia management Conservative management
Conclusions
- Endometrial ablation and/or resection offer a safe alternative to hysterectomy as a surgical treatment for heavy menstrual bleeding.
- Both procedures are ef fect ive , and
satisfaction rates are high (> 85%). - The initial cost of endometrial destruction is
signif icantly lower than the cost of hysterectomy.
Thank you for your attention
