Radiological assessment of the placement of Essure in order to reduce hysterosalpingography: Pelvic X-ray versus combined pelvic X-ray and ultrasound.

Objective: Three months after hysteroscopic sterilisation with Essure, a confirmation test is required to evaluate the correct location of the inserts. The test may be conducted using a pelvic ultrasound (2D or 3D) or an abdominal X-ray. Should the location not look satisfactory on these tests, a follow-up hysterosalpingography (HSG) would be required. The objective of our study is to assess whether the Essure 3-month confirmation test using a single X-ray or a combination of X-ray and ultrasound could reduce the use of HSG.

Study Design: This retrospective study examined patients who underwent birth control Essure procedure between 2009 and 2015 in the Gynaecological Surgery Department at the Regional University Hospital Centre (CHRU) in Lille. We divided patients into two groups based on the imaging tests performed: single X-ray (2009-2010) versus X-ray and pelvic ultrasound (2014-2015). We then compared the results of the imaging tests and the use of HSG between the two groups.

Results: One hundred and thirty-four patients were tested, of which 60 (44.8%) using a single X-ray and 74 (55.2%) using a combination of X-ray and ultrasound. We note that the combined X-ray/ultrasound test reduces significantly the number of HSG performed (26.7% versus 12.2%, P=0.04).

Conclusion: Compared to a single X-ray, the combination of X-ray and ultrasound enables to significantly limit the use of HSG.