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of the lectures at the end
of the three days, resulting in “take home
messages” for the individual clinician and
the conclusion that evidence based medical education
can change clinical practice and thus ensure the
best interest of the patients.
Main aspects
The opening lecture, “The patient as a partner”,
set the scene for the importance of multi-disciplinary
collaboration in dealing with the challenges of
endometriosis, and for making progress at legislative
level as has recently been demonstrated with the
European Commission. It was delivered by Lone Hummelshøj
(UK) who, together with Professor Charles Chapron
(France), also presented on the development and
use of the ESHRE
guideline for the diagnosis and treatment of endometriosis.
Professor Chapron also discussed his experience
with the surgical treatment of deeply infiltrating
endometriosis and presented results of trans-rectal
ultrasound. Ultrasound may be the first option of
image evaluation for deeply infiltrating endometriosis,
and which in experienced hands can give a precise
evaluation of lesions.
Harry Reich (USA)
talked about hysterectomy and endometriosis and
the evolution of the surgical treatment over the
last three decades. He demonstrated that nowadays
laparoscopic surgery is the main treatment for tadvanced
disease. Peter Maher (Australia) presented lectures
on colorectal surgery and the overall complications
of surgical treatment, concluding how important
it is to make proper decisions about surgical treatments
in order to avoid complications.
During the meeting
it became apparent that the intense research activity
developed in Brazil contributed to a highly interactive
meeting, which included: epidemiology, genetics,
immunology, diagnosis and treatment of the disease
Recent studies about genetics, ambiental factors,
imaging diagnosis, treatment of infertile patients
as the association between endometriosis and cancer
were presented.
Assessing
the impact of attending a congress
As a unique component, we
decided to assess on the last day if the messages
delivered by our key note speakers had had any influence
on the way in which the delegates would go back
and continue their clinical practice.
Prior to the congress,
the website www.endometriose2006.net
had posed seven questions regarding various aspects
of the clinical management of endometriosis, and
had gathered opinions from more than 200 gynaecologists,
radiologists colorectal surgeons, and urologists.
On the last day
of the congress, we carried out the “Brazilian
Consensus on the Diagnosis and Treatment of Endometriosis”,
where Brazilian participants voted again in an interactive
session on how to deal with:
• diagnosis
• treatment of pain
• infertility
• ovarian disease
• deeply infiltrating endometriosis.
The original answers
(pre-congress) were then compared to the results
obtained at the end of the meeting. And there was
a difference! In dealing with ovarian disease the
most frequent answer before the meeting was to aspirate
the ovarian endometrioma, whereas after the meeting,
where the evidence of the ESHRE guideline had been
presented, the most frequent answer was to remove
the capsule of the ovarian endometrioma.
Analysing the clinical
treatment, physicians re-evaluated the indications
of the use of GnRH-analogues, following an interactive
discussion at the meeting. The question, which had
been asked was:
CASE STUDY: infertile patient of 34 years with
severe pain and deep endometriosis compromising
the rectum. Imaging methods show the lesion compromising
the layers serosa, muscularis and submucosa. The
investigation of the male factor was normal.
What would
you recommend?
48.3% (before the
meeting) and 11.9% (at the end of the meeting) of
our colleagues answered that three months of GnRH-analogues
would be indicated and after this period, the patient
should be submitted for laparoscopic surgery. 33.3%
(before the meeting) and 52.4% (at the end of the
meeting) of our colleagues answered that surgical
treatment of the bowel disease would be the best
treatment.
In summary, after
the meeting the indication of preoperative treatment
with GnRH-analogues for bowel endometriosis decreased
and the indication for surgical treatment in patients
with severe pain increased.
Conclusion
The aim of Endometriose2006 was to provide state
of the art presentations on one topic (in this case:
endometriosis) in a “one-room” scenario
(ie. no parallel/competing sessions) to enable discussion
and to aid clinicians to contribute with feedback/experience
of their day-to-day practice.
We succeeded by
ensuring that the key messages, based on the latest
available evidence, were delivered by national and
international specialists in endometriosis in a
way that could be effectively applied in clinical
practice.
In evaluating
the “take-home-message”, both before
and after the congress, by asking for feedback on
“seven issues”, we proved that from
an educational point of view well presented up-to-date
clinical evidence can aid in, and potentially change,
clinical practice. This becomes increasingly important
with the development of new tools for pre-operative
diagnosis of the disease, to ensure that the best
decisions about individual treatments for the patients
are chosen, Educational meetings such as these can
aid in ensuring that ongoing emphasis is placed
on evidence based medicine and the clinical application
of this.
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