Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

The 10 “Cardinal Sins” in the Clinical Diagnosis and Treatment of Endometriosis: a Bayesian Approach

Philippe R Koninckx
* ORCID logo ,
Anastasia Ussia
,
Stephan Gordts
ORCID logo ,
Jörg Keckstein
,
Ertan Saridogan
,
Malzoni Mario
,
Assia Stepanian
,
António Gutierrez Setúbal
ORCID logo ,
Leila Adamyan
,
Arnaud Wattiez
Version 1 : Received: 13 June 2023 / Approved: 14 June 2023 / Online: 14 June 2023 (07:38:32 CEST)

A peer-reviewed article of this Preprint also exists.

Koninckx, P.R.; Ussia, A.; Gordts, S.; Keckstein, J.; Saridogan, E.; Malzoni, M.; Stepanian, A.; Setubal, A.; Adamyan, L.; Wattiez, A. The 10 “Cardinal Sins” in the Clinical Diagnosis and Treatment of Endometriosis: A Bayesian Approach. J. Clin. Med. 2023, 12, 4547. Koninckx, P.R.; Ussia, A.; Gordts, S.; Keckstein, J.; Saridogan, E.; Malzoni, M.; Stepanian, A.; Setubal, A.; Adamyan, L.; Wattiez, A. The 10 “Cardinal Sins” in the Clinical Diagnosis and Treatment of Endometriosis: A Bayesian Approach. J. Clin. Med. 2023, 12, 4547.

Abstract

Evidence-based data for endometriosis management are limited. Experiments are excluded without adequate animal models. Data are limited to symptomatic women and occasional observations. Hormonal medical therapy cannot be blinded if recognised by the patient. Randomised controlled trials are not realistic for surgery since a variable disease with low numbers. Each diagnosis and treatment is an experiment with an outcome and experience is Bayesian updating from the past. If the experience of many is similar, this has more value than an opinion. The combined experience of a group of endometriosis surgeons was used to discuss problems in the management of endometriosis. Considering endometriosis as several genetically/epigenetically different diseases is important for medical therapy. Imaging cannot exclude endometriosis and diagnostic accuracy is limited for superficial lesions, deep lesions, and cystic corpora lutea. Surgery should not be avoided for emotional reasons. Shifting infertility treatment to IVF without considering fertility surgery is questionable. The concept of complete excision should be reconsidered. Surgeons should introduce quality control and teaching should move to explain why it is done. The perception of information has a personal bias. These are the major problems in the management of endometriosis identified by the combined experience of endometriosis surgeons.

Keywords

Endometriosis diagnosis; endometriosis therapy; endometriosis surgery; Bayesian statistics; evidence-based medicine

Subject

Medicine and Pharmacology, Clinical Medicine

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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