Laparoscopic use of ethanol sclerotherapy in the treatment of endometriomas: a narrative review.

OBJECTIVE: Endometriosis frequently involves the ovaries. Surgical management of endometriomas traditionally includes cystectomy, electrocoagulation, or ablative techniques. Ethanol sclerotherapy has emerged as a low-cost, time-efficient alternative. When performed laparoscopically, it allows simultaneous management of superficial and deep endometriosis and offers flexibility in cases of cyst rupture. This narrative review aims to summarize the current evidence regarding the use of laparoscopic ethanol sclerotherapy for endometriomas. DATA SOURCES: A comprehensive literature search was conducted in PubMed, Embase, Web of Science, SCOPUS and the Cochrane Library using three key concepts-endometriosis, laparoscopy, and sclerotherapy-combined with the Boolean operator "AND." Reference lists of included studies were screened to identify additional publications. METHODS OF STUDY SELECTION: Outcomes of interest included efficacy, safety, ovarian reserve, and recurrence after laparoscopic use of ethanol sclerotherapy. TABULATION, INTEGRATION AND RESULTS: The search yielded 271 records. After removal of duplicates, 146 titles and abstracts were screened. One additional study was identified by e-mail alert. Eight studies underwent full-text assessment. Three were excluded due to wrong study design and one due to overlap in study population. The four included trials consisted of one RCT, one observational study and two retrospective studies (all single-center). CONCLUSION: Laparoscopic ethanol sclerotherapy appears to be a feasible and safe alternative for the treatment of endometriomas. However, existing data are limited and heterogeneous. Large, multicenter randomized controlled trials comparing sclerotherapy with cystectomy or ablation, while accounting for postoperative hormonal therapy, are needed to define its role in clinical practice.