To assess the feasibility of percutaneous radiofrequency ablation (PRFA) on anterior abdominal wall endometriosis (AWE) lesions and to describe its safety and efficacy on clinical symptoms and on the volume of the lesion.

Design:

Interventional, prospective, non-comparative, phase 1 clinical trial.

Setting:

Patients consulting at the multidisciplinary endometriosis expert center at Croix Rousse University Hospital (Hospices Civils de Lyon).

Patients or Participants:

Ten patients with 1 to 3 AWE lesions treated by PRFA with 6 months follow-up.

Interventions:

PRFA of AWE lesions were performed under ultrasound guidance. Initial power ranged from 3 to 10 W, with progressive increases in power. The thermal effect in the ablation zone was monitored in real time (appearance of hyperechoic signals). A contrast-enhanced ultrasound check was also carried out. We used multiShot technique until the entire nodule was covered by the hyperechogenic cloud.

Measurements and Main Results:

Ten patients (12 nodules) were positively treated from 25/06/2020 to 27/07/2022, 8 under local anesthesia and 2 under general anesthesia, which represented 100% feasibility.

Nine patients had previous caesarean section.

At 6 months the nodule pain at palpation disappeared for 9 patients (90%), mean cyclic pain VAS significantly decreased from 5.7 points (0.9 SD 0.9 VS 6.6 SD 3.2 p=.03) and non-cyclic pain from 3.8 points (0.8 SD 1.3 vs 4.6 SD 3.3 p=.02). Patients reported a significant improvement of their quality of life at 6 months (SF36 total score increase by 218 points p<.01).

We observed a significant reduction of 78% in the volume of the nodule at 6 months on MRI (1.2cm3 SD 1.3 vs 5.4cm3 SD 8.2 p<.01) ; 11/12 treated nodules were non-vascularized/enhanced on post-procedure MRI.

All Patients were treated on an outpatient basis.

We report one severe adverse event (incisional hernia).

Conclusion:

PRFA is a safe and clinically effective treatment of AWE.