Journal of the European Society for Gynaecological Endoscopy


A proof of concept that experience-based management of endometriosis can complement evidence-based guidelines

A. Wattiez1,2, L. Schindler3, A. Ussia4, R. Campo5, J. Keckstein6, G. Grimbizis7, C. Exacoustos8, W. Kondo9, C. Nezhat10, M. Canis11, R.L. De Wilde12, C. Miller13, A. Fazel14, B. Rabischong15, A. Graziottin16, P.R. Koninckx1,17

1 Latifa Hospital Dubai, UAE
2 Prof. Department of Obstetrics and Gynaecology, University of Strasbourg, France
3 Bourn Hall Fertility Clinic- Mediclinic Dubai
4 Consultant Università Cattolica, Dpt OBGYN Roma Italy
5 Life Expertcenter, Leuven, Belgium
6 Endometriosis Centre, Dres. Keckstein- Villach, Austria and University Ulm, Dpt ObGyn Ulm, Germany
7 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece
8 Associate Professor of Obstetrics and Gynaecology at the University of Rome Tor Vergata, Italy
9 Centro Avançado de Cirurgia Ginecológica, Curitiba, Brazil
10 Nezhat Medical Center, Atlanta GA
11 Department Obstetrics gynaecology, CHU Estaing, Clermont-Ferrand, France
12 University Hospital for Gynecology, University Medicine Oldenburg, Carl von Ossietzky University, Germany
13 Professor, Obstetrics and Gynecology, Department of Clinical Sciences, Rosalind Franklin University of Medicine and Science, North Chicago, IL USA. Director, Minimally Invasive Gynecologic Surgery, Advocate Lutheran General Hospital, Park Ridge, IL USA;
14 Assistant Professor, Obstetrics and Gynecology and Inserm U 1275, CAP Paris-Tech Hôpital Lariboisière, Paris, France
15 Gynaecological Surgery Department CHU Estaing, Clermont-Ferrand, France
16 Consultant Professor, University of Verona, Italy, Lecturer, Federico II University, Naples, Italy; Director, Center of Gynecology and Medical Sexology H. San Raffaele Resnati, Milan, Italy
17 Professor emeritus ObGyn KULeuven Belgium, University of Oxford, and Hon Consultant, UK, University Cattolica, Roma, Italy and Moscow State Univ, Russia


Experience-based, evidence-based, endometriosis, guidelines, Bayesian, endometriosis management

Published online: Sep 24 2023


Background: Management of endometriosis should be based on the best available evidence. The pyramid of evidence reflects unbiased observations analysed with traditional statistics. Evidence-based medicine (EBM) is the clinical interpretation of these data by experts. Unfortunately, traditional statistical inference can refute but cannot confirm a hypothesis and clinical experience is considered a personal opinion.

Objectives: A proof of concept to document clinical experience by considering each diagnosis and treatment as an experiment with an outcome, which is used to update subsequent management.

Materials and Methods: Experience and knowledge-based questions were answered on a 0 to 10 visual analogue scale (VAS) by surgery-oriented clinicians with experience of > 50 surgeries for endometriosis.

Results: The answers reflect the collective clinical experience of managing >10.000 women with endometriosis. Experience-based management was overall comparable as approved by >75% of answers rated ≥ 8/10 VAS. Knowledge-based management was more variable, reflecting debated issues and differences between experts and non-experts.

Conclusions: The collective experience-based management of those with endometriosis is similar for surgery-oriented clinicians. Results do not conflict with EBM and are a Bayesian prior, to be confirmed, refuted or updated by further observations.

What is new? Collective experience-based management can be measured and is more than a personal opinion. This might extend EBM trial results to the entire population and add data difficult to obtain in RCTs, such as many aspects of surgery.