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Transforming the #Enzian Classification Into a Four-Stage System: A Feasibility Study by Comparison With the 2021
Nikolaus Fadinger1, Peter Oppelt1, Philip Sebastian Trautner1
1Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Johannes Kepler University Linz (Fadinger, Oppelt, Trautner, Szilagyi, Enzelsberger), Linz, Austria.
Study Objective:
To develop a translation model of the #Enzian classification into a 4-stage system and to evaluate its performance in a retrospective endometriosis cohort.
Design:
Feasibility study consisting of 2 parts: First, the allocation of points for the translation model of the #Enzian classification into a 4-stage system. Second, the comparison between the AAGL2021 stages and the new #Enzian stages in a retrospective cohort of patients with endometriosis surgery.
Setting:
Tertiary center in Europe.
Participants:
222 endometriosis patients who underwent laparoscopic surgery with perioperative documentation of both classifications.
Interventions:
The basic structure of the translation model was defined according to the point values used in the AAGL2021 classification for different anatomical locations. In the absence of a direct translation option, the corresponding points for the #Enzian compartments were determined in a survey of 3 experienced endometriosis surgeons. The final 4-stage system was then tested against the AAGL2021 classification in a retrospective dataset.
Results:
The distribution of endometriosis stages was similar between the 2 classifications, with a comparable percentage of patients in each stage (stage 1: 43% and 44%, stage 2: 20% and 24%, stage 3: 11% and 9%, stage 4: 27% and 21% for the #Enzian and AAGL2021 classifications, respectively). However, the composition of the stages differed slightly, especially in stages 2 and 3, which was shown in a Sankey diagram. Certain deep endometriotic lesions in compartment B and adenomyosis are not respected in the AAGL2021 classification.
Conclusion:
The #Enzian classification can be easily converted to a 4-stage scoring system similar to the AAGL2021 classification. Perhaps future research could help to determine appropriate point values based on different outcome parameters (e.g., pain, infertility, surgical complexity, …).
