Letters

Evidence on endometriosis

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7268.1077/a (Published 28 October 2000) Cite this as: BMJ 2000;321:1077

Elitism about randomised controlled trials is inappropriate

  1. D Redwine, consultant gynaecologist.,
  2. C H Mann, specialist registrar.,
  3. J T Wright, consultant gynaecologist. (jwrighta@cix.co.uk)
  1. St Charles Medical Center, Bend, OR 97701, USA
  2. Birmingham Women's Hospital, Birmingham B15 2TG
  3. Woking Nuffield Hospital, Woking, Surrey GU21 4BY
  4. Center for Practice and Technology Assessment, Agency for Healthcare Research and Quality, Rockville, MD 20852, USA

    EDITOR—The article by Farquhar focuses on evidence from randomised controlled trials for the effective treatment of endometriosis.1 A casual reader could conclude that these trials are the only evidence for effective treatment.

    The definitive treatment of endometriosis is simple: surgical eradication. The success of surgical treatment is best assessed by determining how much disease, if any, remains after operative intervention. This must include appropriate mapping of endometriotic deposits. Excision biopsy is the most effective way of treating both superficial and deeply invasive disease and allowing histological confirmation. It has been shown to have a cure rate of 57-66% at re-evaluation. 2 3

    There are no such follow up data for patients treated by laser vaporisation or electrocoagulation. The randomised controlled trials cited in Farquhar's article have focused on pain or infertility. They do not answer the question of efficacy in destroying the disease.

    If …

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