Focused Ultrasound Therapy
Focused ultrasound is a noninvasive, therapeutic technology with the potential to improve the quality of life and decrease the cost of care for patients with endometriosis. This novel technology focuses beams of ultrasound energy precisely and accurately on targets deep in the brain without damaging surrounding normal tissue.
How it Works
Where the beams converge, focused ultrasound produces precise ablation (thermal destruction of tissue) enabling endometriosis to be treated without surgery.
Focused ultrasound is already being used to treat adenomyosis (growth of endometrial tissue in the uterine wall). When endometrial tissue grows on organs outside of the uterus (endometriosis), focused ultrasound may be considered as an alternative treatment. This is still very early work, but the positive preliminary results are encouraging.
Dr. Gil Dubernaud and his team in France investigating focused ultrasound for treatment of deep infiltrating endometriosis – one of the most common and symptomatic types of endometriosis – which involves the bowel 8-12% of the time. Conventional treatment options for this condition include colon resection or rectal shaving. Dr. Dubernaud’s team is using transrectal focused ultrasound to treat the rectal or sigmoid endometriotic nodules.
Advantages
The primary option for treatment of endometriosis is surgical excision, although there are some medications which have also been used.
For certain patients, focused ultrasound could provide a noninvasive alternative to surgery with less risk of complications – such as surgical wound healing or infection – at a lower cost. It can reach the desired target without damaging surrounding tissue and is repeatable, if necessary.
Clinical Trials
A multi-site clinical trial is treating the symptoms of rectal endometriosis in France.
Regulatory Approval and Reimbursement
Focused ultrasound treatment for endometriosis is not yet approved by regulatory bodies or covered by medical insurance companies.
Notable Papers
Razakamanantsoa L, Bodard S, Najdawi M, Dabi Y, Bendifallah S, Touboul C, Lehrer R, Agbonon R, Di Giuseppe R, Barral M, Bazot M, Brun JL, Roman H, Marcelin C, Thomassin-Naggara I, Cornelis FH. Surgical and Percutaneous Image-guided Therapies of Abdominal Wall Endometriosis: a Systematic Review of Current Evidence. J Minim Invasive Gynecol. 2024 Jun 18:S1553-4650(24)00266-8. doi: 10.1016/j.jmig.2024.06.007. PMID: 38901689
Ali MM, Awad Elderiny H, Shaaban Abdelgalil M, Mohamed Othman A. Is high-intensity focused ultrasound a magical solution to endometriosis? A systematic review. Proc (Bayl Univ Med Cent). 2024 Jun 4;37(4):625-637. doi: 10.1080/08998280.2024.2352290. eCollection 2024. PMID: 38910796
Dubernard G, Maissiat E, Legendre G, Dennis T, Capmas P, Warembourg S, Descamps P, Chavrier F, Roman H, Fernandez H, Nguyen-Ba E, Merlot B, Rousset P, Lafon C, Philip CA. Evaluating the safety of high-intensity focused ultrasound treatment for rectal endometriosis: results from a French prospective multicentre study including 60 patients. Hum Reprod. 2024 Jun 24:deae127. doi: 10.1093/humrep/deae127. PMID: 38914481
Knorren ER, de Ridder LA, Nijholt IM, Dijkstra JR, Braat MNGJA, Huirne JAF, Boomsma MF, Schutte JM. Effectiveness and complication rates of high intensity focused ultrasound treatment for abdominal wall endometriosis: A systematic review. Eur J Obstet Gynecol Reprod Biol. 2024 Jun;297:15-23. doi: 10.1016/j.ejogrb.2024.03.029. Epub 2024 Mar 26. PMID: 38555851
Li JX, Li XL, Zhu JE, Zhang HL, Yu SY, Xu HX. Ultrasound-guided microwave ablation for symptomatic abdominal wall endometriosis and treatment response evaluation with contrast-enhanced imaging: The first experience. Clin Hemorheol Microcirc. 2022 Jun 2. doi: 10.3233/CH-211287.
Zhang X, Duan H. One-time high-intensity focused ultrasound ablation of abdominal wall endometriosis with concurrent uterine fibroids or adenomyosis: two cases and literature review. Quant Imaging Med Surg. 2020 Feb;10(2):511-517. doi: 10.21037/qims.2019.12.07. No abstract available.
Nguyen MD. Magnetic Resonance Imaging-guided High-intensity Focused Ultrasound Ablation for Endometriosis of the Abdominal Wall. Gynecol Minim Invasive Ther. 2020 Jan 23;9(1):45-46. doi: 10.4103/GMIT.GMIT_47_19. eCollection 2020 Jan-Mar. No abstract available.
Philip CA, Warembourg S, Dairien M, Lefevre C, Gelet A, Chavrier F, Guillen N, Tonoli H, Maissiat E, Lafon C, Dubernard G. Transrectal high-intensity focused ultrasound (HIFU) for the management of rectosigmoid deep infiltrating endometriosis: results of phase I clinical trial. Ultrasound Obstet Gynecol. 2019 Dec 1. doi: 10.1002/uog.21937.
Zhao L, Deng Y, Wei Q, Chen J, Zhao C. Comparison of ultrasound-guided high-intensity focused ultrasound ablation and surgery for abdominal wall endometriosis. Int J Hyperthermia. 2018 Sep 13:1-6. doi: 10.1080/02656736.2018.1511836.
Stehouwer BL, Braat MNG, Veersema S. Magnetic Resonance Imaging Guided High Intensity Focused Ultrasound is a Non-Invasive Treatment Modality for Patients with Abdominal Wall Endometriosis. J Minim Invasive Gynecol. 2018 Mar 30. pii: S1553-4650(18)30175-4. doi: 10.1016/j.jmig.2018.03.018.
Dubernard G, Gelet A, Lafon C, et al. Transrectal high-intensity focused ultrasound as focal therapy for posterior deep infiltrating endometriosis. Ultrasound Obstet Gynecol. 2018;51(1):145-146. doi:10.1002/uog.17497.
Zhu X, Chen L, Deng X, Xiao S, Ye M, Xue M. A comparison between high-intensity focused ultrasound and surgical treatment for the management of abdominal wall endometriosis. BJOG. 2017 Aug;124 Suppl 3:53-58. doi: 10.1111/1471-0528.14737.
Zhang L, Rao F, Setzen R. High intensity focused ultrasound for the treatment of adenomyosis: selection criteria, efficacy, safety and fertility. Acta Obstet Gynecol Scand. 2017 Jun;96(6):707-714. doi: 10.1111/aogs.13159.
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