Endometrial ablation with a thermal balloon: the first 10 years

Thermal balloon endometrial ablation (BEA) was introduced approximately 10 years ago as the first automated replacement for hysteroscopic endometrial ablation (HEA) in women with chronic abnormal uterine bleeding. Putative advantages included similar or improved clinical outcomes, and reduction of both adverse outcomes and the total cost of care, all with reduced requirements for operator skill. The published literature contains 1191 cases of BEA performed with instruments from 4 manufacturers, including a number of randomized clinical trials (RCTs) comparing the devices with HEA, usually performed by experts. In comparative RCTs, clinical and health-related quality of life outcomes as well as patient satisfaction and rate of subsequent uterine surgery appear similar in follow-up intervals that ranged from 1 to 5 years. There is a suggestion of reduced risk of adverse events with BEA, but the differences are small. There are no rigorous evaluations of resource use. The level of surgeon expertise in HEA arms of available RCTs potentially improves quality and decreases complications over what might be expected in the general population. Thus BEA seems equivalent to HEA when performed by expert surgeons with respect to most outcomes. Effectiveness studies of the two interventions should be conducted in community settings and should evaluate resource use.