ABSTRACT

Organisation of care for endometriosis patients – role of reference centre

This article sets out to define the roles of individual specialists in the treatment and diagnosis of patients with suspected deeply infiltrating endometriosis. We are currently experiencing growing rates of endometriosis, but at the same time there has been progress in diagnostic and therapeutic techniques, including both pharmacotherapy and surgery. Despite these advances, diagnostic delays are still experienced, leaving endometriosis patients to suffer, sometimes for as many as 8-10 years, before being correctly diagnosed. At the same time, increasing attention is drawn to the importance of reference centres, which may play a critical role in both diagnosis and treatment of endometriosis. Reference centres provide access to specialised equipment and employ highly specialised personnel, affording continuous availability of the diagnostic/therapeutic team for endometriosis sufferers. These measures prevent the need for emergency surgery performed at centres that lack the necessary experience, resources or necessary collaboration with other specialists Such surgery does not ensure eradication of endometriosis and leads to persistent symptoms and frequent recurrences. It has been demonstrated that first surgery for endometriosis is crucial for the future course of the disease: if all infiltrative lesions present are excised, the risk of a recurrence is much lower, including both pain and the need for repeat surgery. According to ESHRE recommendations, laparoscopy should never be diagnostic, but always therapeutic. Advances in diagnostic modalities, and particularly ultrasound and MRI, have enabled high-sensitivity non-invasive diagnostic work-up for endometriosis. However, it needs to be noted that these examinations are highly sensitive and specific only when performed by experienced personnel using good quality equipment. Of importance is also the amount of time that can be allotted to an examination and the count of endometriosis cases diagnosed at a particular centre. Accordingly, the referral of a patient with suspected endometriosis to a reference centre accumulating similar cases enables precise staging and designing a management plan. Endometriosis reference centres also play an important role regarding surgical treatment. A correct decision regarding the extent of surgery can be taken primarily owing to the experience of the gynaecologist specialising in the treatment of endometriosis. Equally important are the nursing and anaesthetist team and close collaboration with other specialists (surgeon, urologist) practising surgery for endometriosis daily.

At the same time, the role of the primary care doctor and attending gynaecologist should not be ignored as these professionals, when appropriately prepared, can identify the symptoms and select patients with suspected endometriosis. In this way, they can considerably shorten the time to correct diagnosis, when the patient suffers from pain that significantly affects both her daily life and the professional and personal dimensions of social functioning.

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