Blind Biopsy Can Miss Diagnoses and May Add to Treatment Delays

In the evaluation of abnormal uterine bleeding (AUB), blind biopsy alone can miss diagnoses of up to 18% of patients and may add to treatment delays.


If cancer occupies less than 50%

of the surface area of the endometrial cavity, the cancer can be missed by a blind biopsy1

Blind biopsy alone could miss the diagnosis of focal lesions in

up to 18% of patients2

Use Direct Visualization at Point-of-Care

In premenopausal ovulatory women with AUB,
hysteroscopy will detect an anatomical structural lesion

in 65-80% of patients3

Diagnose More Accurately

Endosee allows you to diagnose uterine focal pathology more accurately than endometrial biopsy alone.

Sensitivity for diagnosing polyps1

Blind Biopsy
11%

Hysteroscopy
89%

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Sensitivity for diagnosing myomas1

Blind Biopsy
13%

Hysteroscopy
100%

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Sensitivity for diagnosing hyperplasia1

Blind Biopsy
25%

Hysteroscopy
74%

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Save Time and Resources

Office
Hysteroscopy VS
Diagnostic Hysteroscopy
In the OR

Office hysteroscopy can help decrease the rate of diagnostic hysteroscopy in the OR under anesthesia5

Cost-Effectiveness of Office Hysteroscopy – Study

Savings of
$1,498
Per Patient

75 of 130 women who underwent diagnostic office hysteroscopy for abnormal bleeding did not need to undergo hysteroscopy in the OR. This represents estimated savings of $1,498 per patient.5

Cost-Effectiveness of Office Hysteroscopy – Study

Feedback from 106 Endosee Trials with 42 Clinicians

Speed of Procedure:

  • Average time per procedure: Less than 3 minutes
  • Average time doctors were in the exam room per procedure: Less than 13 minutes
  • “With Endosee, we can turn over the room in 20 minutes” – Physician feedback

Visualization:

  • Cases in which visualization was reported “excellent” or “adequate”* 98%
  • Procedures with anatomical challenges in seeing the complete uterine cavity+ 9%

*Remaining 2% of procedures were stopped prematurely due to patient request.
+Severe obstruction due to Asherman’s syndrome, multiple polyps or fibroids, or if severely anteflexed uterine position.

Patient Comfort:

  • Patients reporting no discomfort or mild discomfort* 91.5%
  • Procedures in which NSAIDs were used 44.2%
  • Procedures in which a paracervical block was used 37.5%
  • Procedures in which a slight dilation was used 45.1%

*Discomfort reported was mostly due to uterine distention

References

1. ACOG Practice Bulletin Number 128. 2. Goldstein S, Zeltser I, Horan C, et al. Am J Obstet Gynecol. 1997;177:102-108. 3. Isaacson K. Curr Opin Obstet Gynecol. 2002;14:381-385. 4. Garcia A. OBG Manage. 2013;25:44-48. 5. Moawad N, Santamaria E, Johnson M, Shuster J. JSLS. 2014;18:1-5.

“This handheld, portable system can be set up in minutes and in any examination room, so it is not disruptive to my practice or my patients.”

Ethan Goldstein, MD
  • Ethan Goldstein, MD
  • Robotic & Minimally Invasive Surgery Program
  • Huron Valley-Sinai Hospital, Detroit, MI

“Endosee brought about a mind-set change. By using it, you realize that you’re doing patients a service by getting to a diagnosis as soon as possible.”

Ethan Goldstein, MD
  • Ethan Goldstein, MD
  • Robotic & Minimally Invasive Surgery Program
  • Huron Valley-Sinai Hospital, Detroit, MI

“In addition to offering physicians immediate visualization to gather important diagnostic information, Endosee also allows us to perform an endometrial biopsy and hysteroscopy in the same visit.”

Ethan Goldstein, MD
  • Ethan Goldstein, MD
  • Robotic & Minimally Invasive Surgery Program
  • Huron Valley-Sinai Hospital, Detroit, MI

“Dramatic shifts within the Centers for Medicare & Medicaid Services fee schedule in 2017 – and commensurate changes in the private insurance market – have now ramped up [the value of in-office hysteroscopy]… According to national payment amounts, performing this procedure in the office earned an average of $1,382.07 in 2017, compared with $409.60 in 2016.”

Aarathi Cholkeri-Singh, MD
  • Aarathi Cholkeri-Singh, MD
  • University of Illinois, Chicago, IL
  • Advocate Lutheran General Hospital, Park Ridge, IL

“The benefits of integrating hysteroscopy into office practice have been compelling for some time. An in-office approach is patient centered, more efficient, and clinically valuable. It also has had the potential to be economically valuable for practices that are able to perform a mix of diagnostic and therapeutic/operative hysteroscopies.”

Aarathi Cholkeri-Singh, MD
  • Aarathi Cholkeri-Singh, MD
  • University of Illinois, Chicago, IL
  • Advocate Lutheran General Hospital, Park Ridge, IL

“In addition to reimbursement levels, it’s important to consider the efficiencies of in-office hysteroscopy. The setup is relatively simple and requires a dedicated exam room, not a surgical suite... Hysteroscopy at the hospital, or even at an ambulatory surgical center, involves time driving, changing, and waiting for anesthesia.”

Aarathi Cholkeri-Singh, MD
  • Aarathi Cholkeri-Singh, MD
  • University of Illinois, Chicago, IL
  • Advocate Lutheran General Hospital, Park Ridge, IL

“For our patients… an in-office approach offers less out-of-pocket expense (deductibles), less time away from family/work, avoidance of general anesthesia/intubation, and greater patient comfort from being within a familiar environment. For diagnostic procedures, the patient can be in and out in less than 30 minutes, and for operative procedures, she can be in and out in 1-2 hours, compared with more than 4 hours at the hospital.”

Aarathi Cholkeri-Singh, MD
  • Aarathi Cholkeri-Singh, MD
  • University of Illinois, Chicago, IL
  • Advocate Lutheran General Hospital, Park Ridge, IL

“[Before January, 2017,] higher procedural costs in the office…actually discouraged the physician who wanted to perform cases in the office. [The] increase in the reimbursement for hysteroscopic endometrial biopsy and/or polypectomy…creates a distinct monetary advantage, which along with increased physician efficiency and patient comfort, has led to more physicians bringing these surgeries to an in-office setting.”

Charles E. Miller, MD
  • Charles E. Miller, MD
  • University of Illinois, Chicago, IL
  • Lutheran General Hospital, Park Ridge, IL

No longer is hysteroscopy considered experimental or of dubious value. My hysteroscope is my stethoscope. It allows me to evaluate myriad gynecologic conditions: infertility, endometrial polyps, heavy menstrual bleeding, irregular menstrual cycles, equivocal findings on transvaginal ultrasound and imaging, postmenopausal bleeding, leukorrhea, intracavitary leiomyoma, retained products of conception, post-operative healing after Asherman’s, myomectomy, and foreign bodies.”

Linda Bradley
  • Linda Bradley
  • Professor of Surgery at Cleveland Clinic
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