Hysteroscopic features suggestive of chronic endometritis: a systematic review

AbstractThe purpose of this systematic review is to identify common hysteroscopic findings suggestive of endometritis, chronic or subclinical, based on current scientific evidence. Data sources were MEDLINE, Embase, PubMed and other sources of grey literature. Four (4) authors independently selected studies addressing hysteroscopic detection of CE based on specific and clearly stated hysteroscopic criteria. The diagnosis was confirmed by histologic assessment, as stated in the materials and methods of these studies included. The initial search identified 599 studies, of which 21 met the inclusion criteria. Significant heterogeneity among published studies on Chronic endometritis (CE) remains the main limitation in performing a metanalysis and further analysis of diagnostic accuracy on the subject. Hysteroscopy is an important diagnostic tool in cases of chronic endometritis when accompanied by endometrial biopsies. Clinicians relate hyperaemia and endometrial oedema with chronic endometritis while more than half include micropolyposis as a pathognomonic feature of this subclinical condition. Micropolyps, stromal oedema, haemorrhagic spots, strawberry aspect, and hyperaemia are proposed as adequate indicators of hysteroscopic evidence of CE according to the literature. The impact of CE in long-term reproductive outcomes remain unclear, thus clinicians ought to communicate this to the patients and provide treatment where clinically appropriate. In addition, we present hysteroscopic images of histologically confirmed CE cases that could play the role of a hysteroscopic atlas.Keywords: Hysteroscopychronic endometritisstrawberry aspectendometrial oedemahyperaemiamicropolyps Authors' contributionOT is the first author and was responsible for review conception, manuscript formation and data analysis. FG and ZB assisted throughout this project in study selection and eligibility criteria application. ED evaluated the strengths and limitations of previously published scientific evidence and edited the images for quality and resolution. KT and AV evaluated the data and edited the final form of the manuscript. MP supervised the project, the final form of th manuscript and licensed the photos for this project.Disclosure statementNo potential conflict of interest was reported by the author(s).Images reveal common hysteroscopic findings suggestive of Chronic Endometritis. Endometrial biopsies were obtained by all presented cases and final diagnosis of CE was set by histology. Copyright Professor Minas Paschopoulos.Additional informationFundingAll authors received no funding or grant for this project.