Selecting distending medium for out-patient hysteroscopy. Does it really matter?

Area of Science:

• Gynecology
• Minimally Invasive Surgery
• Diagnostic Imaging

Background:

• Outpatient hysteroscopy is a key diagnostic tool for evaluating the endometrial cavity.
• The choice of distending medium, such as carbon dioxide (CO2) or normal saline, can influence diagnostic accuracy and patient experience.

Purpose of the Study:

• To prospectively evaluate and compare the diagnostic accuracy of carbon dioxide (CO2) versus normal saline as distending media in outpatient hysteroscopy.
• To assess patient discomfort associated with each distending medium during the procedure.

Main Methods:

• A prospective randomized study involving women undergoing hysterectomy compared diagnostic hysteroscopy using CO2 (n=39) or normal saline (n=35) 12-24 hours pre-surgery.
• Patient-reported symptoms were recorded on a 4-point scale.
• Hysteroscopic findings were validated against macroscopic and histological examination of surgical specimens.

Main Results:

• Hysteroscopy completion rates were high for both groups (89.74% for CO2, 97.14% for saline).
• Diagnostic accuracy for major pathologies (large polyps, myomas, hyperplasia) was similar between CO2 and normal saline groups.
• Normal saline demonstrated significantly higher diagnostic accuracy (85.4%) for detecting minor endometrial pathologies compared to CO2 (64.6%).

Conclusions:

• Carbon dioxide (CO2) and normal saline are comparable in terms of patient discomfort and the detection of major endometrial pathologies during outpatient hysteroscopy.
• Normal saline is the preferred medium for enhancing diagnostic accuracy when identifying minor pathologies within the endometrial cavity.