Percutaneous Cryoablation Therapy for Abdominal wall Endometriosis: a Systematic Review and Meta-analysis

Abdominal wall endometriosis consists of endometrial tissue between the peritoneum and the abdominal wall. The established treatment involves amenorrheic drugs-not always successful and tolerated-or invasive surgery. In this scenario, minimally invasive techniques such as cryoablation are a potential option. In this study, we primarily aimed to evaluate the efficacy of percutaneous cryoablation in reducing pain scores of abdominal wall endometriosis patients and analyze their satisfaction with the procedure and its related adverse events. MEDLINE, EMBASE, and Cochrane's databases were systematically searched for studies that employed percutaneous cryoablation therapy for abdominal wall endometriosis and reported any of the outcomes of interest. The primary outcome was the reduction in the visual analog scale score after treatment. R Software was used for the statistical analysis. Heterogeneity was assessed using I2 statistics. The Risk Of Bias In Non-Randomized Studies-of Interventions framework assessed potential bias in each selected study. We included 4 studies, containing 126 patients. All articles were retrospective studies. The difference between the visual analog scale scores before and after treatment was on average 5.97 points (95% CI 5.42-6.52; p < 0.01; I2 = 0%). The pooled satisfaction rate among patients in the selected studies was 93.1% (95% CI 88.66-97.34; p = 0.51; I2=0%). The pooled prevalence of adverse events was only 5.48% (95% CI 1.71-11.20; p = 0.58; I2=0%). Bias analysis showed an overall moderate risk in all included articles. Our study demonstrated that cryoablation could reduce pain complaints in patients, while presenting a low incidence rate of adverse effects. Randomized clinical trials with a larger number of patients are necessary for greater conclusions.