ESPRIT, EndometrioSis PRediction and assessment of InflammaTion
Research type
Research Study
Full title
Exploring pre-operative prediction of pelvic endometriosis, the local inflammatory environment and response to surgical treatment.
IRAS ID
296042
Contact name
Thomas Bainton
Contact email
Sponsor organisation
Imperial College London
Duration of Study in the UK
1 years, 10 months, 31 days
Research summary
Research Summary:
Endometriosis is a chronic, painful condition affecting up to 10% of women characterised by deposits of endometrial like cells outside the womb, most often in the pelvis. Symptoms are variable and it is not easily identified on scans. There is currently a long delay between the onset of symptoms and diagnosis, typically of around 8 years, leaving sufferers with pain an uncertainty. Much of this time is spent in primary care. Diagnosis is made by an invasive surgical procedure (laparoscopy) performed under general anaesthesia.Endometriosis sufferers have a comparatively higher incidence of sub-fertility, which may in part be due to inappropriate inflammation in the lining of the womb (endometrium), pelvis and elsewhere. The relationship between the environment inside the womb and the environment in the pelvis is not well understood and the effect of surgically treating endometriosis is unknown.
This study aims to design a scoring system that can be used in primary care to select women at the highest risk of having endometriosis for referral to specialist services for diagnosis and treatment. The score will include symptoms (chronic pelvic pain, pain during periods, intercourse, and opening bowels), clinical history (BMI, family history of endometriosis, and previous pregnancies), and investigations such as pelvic ultrasound findings and CA-125 blood test. A weighting will be applied to each variable providing an overall score. We will apply the scoring system to a group of our patients to assess how well it identifies those with endometriosis.
In order to help determine the cause of endometriosis associated sub-fertility and identify possible targets for future treatment we will investigate how treating pelvic endometriosis impacts the environment in the womb. We will assess the lining of the womb before and after treatment to determine how this changes, which may help identify the root cause.
Summary of Results:
Endometriosis is a common condition that affects about 1 in 10 women of reproductive age. It happens when pieces of the lining of the uterus grow elsewhere in the body, causing symptoms like painful periods, pelvic pain, pain during sex or bowel movements, and difficulty getting pregnant. Diagnosing endometriosis takes 8 years on average, often because symptoms vary and the current method of diagnosis, surgery, is invasive and not easily accessible.The aim of this research was to find a simpler way to tell if a woman might have endometriosis, without needing surgery. We studied 264 women who were already scheduled for surgical investigation of potential endometriosis. Before their surgeries, the women filled out surveys about their symptoms and medical histories and gave blood samples. After surgery, 152 were found to have endometriosis, 97 did not and 15 required further investigation.
We found that a protein called CA125 was more common in the blood of women with endometriosis. Women who reported deep pain during sex and pain with bowel movements were more likely to have endometriosis. Women who had never been pregnant, were slimmer and didn’t smoke were also more likely to have endometriosis. Finally, women who had previously had an ultrasound suggesting endometriosis were more likely to have it confirmed during surgery. By combining all these factors, we created a test that correctly identified about 85% of cases. In future studies, we will check if this test works well in other groups. If it does, it could help women with endometriosis receive a diagnosis more quickly and easily.
REC name
London - Surrey Research Ethics Committee
REC reference
22/PR/0483
Date of REC Opinion
6 Jun 2022
REC opinion
Further Information Favourable Opinion