Feasibility of Percutaneous Radiofrequency Ablation for Abdominal Wall Endometriosis: A Prospective Pilot Study

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

Design: Interventional, prospective, noncomparative, phase 1 clinical trial.

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

Patients: 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 June 25, 2020 to July 27, 2022, 8 under local anesthesia and 2 under general anesthesia, which represented 100% feasibility. Nine patients had previous cesarean section. At 6 months, the nodule pain at palpation disappeared for 9 patients (90%), mean cyclic pain visual analogic scale significantly decreased from 5.7 points (0.9 SD 0.9 vs 6.6 SD 3.2 p = .03) and noncyclic 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 magnetic resonance imaging (1.2 cm³ SD 1.3 vs 5.4 cm³ SD 8.2 p <.01); 11/12 treated nodules were nonvascularized/enhanced on postprocedure magnetic resonance imaging. All Patients were treated on an outpatient basis. We report one severe adverse event (incisional hernia).

Conclusion: PRFA is feasible and may be a clinically effective treatment for AWE.