History: creation of a
center specialized in endometriosis
Why create a specialized endometriosis center?
The creation of expert, referral or specialized endometriosis centers has over the last decade been considered vital in several Western countries, to guarantee better management of severe forms of the disease (1).
International expert centers
From 2005 onwards, in Denmark (population 5.7 million) only two expert centers, one in Aarhus (2) and the other in Copenhagen, have been authorized to treat patients with deep endometriosis (3).
In other countries such as Italy and Brazil, a few centers have opened with a large annual number of patients treated with severe forms of the disease (4-7).
These centers are run by experienced multidisciplinary teams and have rightfully gained international recognition (2,4-7). Nonetheless, the operation of these centers is not generally structured around a network of several centers, with multidisciplinary consultation meetings (RCP) made up almost exclusively of doctors from the center where the expert team is based.
The first endometriosis reference center in France.
In France, the creation of an organized and hierarchical management of the disease has taken shape over the last decade due to the joint action of doctors and patients’ associations, notably EndoFrance.
The proposal for the creation of a pilot multi-site (public and private) and multidisciplinary Endometriosis Reference Center, endorsed by the Rouendometriosis association, Rouen University Hospital and EndoFrance, was submitted to local (Regional Health Agency(ARS)) and national (Ministry of Health) authorities .
The results of this trial were recently presented in a publication available here.
RCPs on endometriosis
In 2016, the Ministry of Health showed increased interest in endometriosis (9), and commissioned the French National Authority for Health (FNAH) to update the Recommendations for Clinical Practice on Endometriosis (RPC), in conjunction with the National College of French Gynecologists et Obstetricians (CNGOF) (10).
The Ministry presented the Normandy pilot project and stated that “the research and experimentation in progress, combined with future FNAH recommendations , will make it possible in 2017 to build a new model for treatment of women with endometriosis. This model will be designed in conjunction with healthcare professionals and patient associations. “In addition, the CNGOF focused on the issue of expert centers for endometriosis and initiated a commission whose work was concluded at the end of 2017 (11,12).
However, as of July 2018, without calling into question the value of expert centers, but noting their saturation due to the very high demand for care, the Ministry of Health focused on the introduction of endometriosis care networks, the aim of which would be to meet needs for diagnosis and first line care.
The missions, characteristics and functioning of these networks have yet to be defined. It nevertheless became rapidly apparent that only Expert Centers had the capacity to organize these networks with their collaborators.
The IFEM Endometriosis Institute was created in 2018 in Bordeaux
The IFEM Endo endometriosis institute was created in 2018 in Bordeaux focusing on endometriosis, led by three passionate gynecologists, whose clinical and research activities are exclusively dedicated to this disease.
Dr Isabella Chanavaz-Lacheray and Prof Horace Roman, who had initiated the Normandy project (8), joined Dr Benjamin Merlot, who had drawn up an identical project involving Bordeaux University Hospital. These 3 doctors had also participated in the development of the recommendations for clinical practice published by the CNGOF in 2017.
The results of the first year of operation of this center have been promising, with a large number of patients treated in consults, by surgery or in outpatients, by a multidisciplinary team bringing together surgeons and practitioners from different specialties (13).
IFEM Endo has a training vocation, participating in post-graduate courses, but also advanced surgical training. 56 international surgeons were trained in our clinic from September 2018 to June 2020.
The clinic works in partnership with European expert centers. Pr Horace Roman is :
- Honorary Professor of Endometriosis Surgery at the University of Aarhus (2),
- Lecturer at the Master of Minimally Invasive Gynecology at the University of Bologna,
- Member of the staff of the International School of Surgical Anatomy (ISSA) of Verona
- Doctor Honoris Causa of the University of Bucharest.
Through its activities, IFEM Endo complies with national and European recommendations on the management of this disease.
Conference “Endometriosis…when to refer to an expert center?”
- Ebert A.D. et al., on behalf of the Endometriosis Research Foundation, and the European Endometriosis League. Implementation of certified endometriosis centers : 5 year experience in German speaking Europe. Gynecol Obstet Invest 2013 ;76 :4-9
- Riiskjaer M, et al. Pelvic organ function before and after laparoscopic bowel resection for rectosigmoid endometriosis: a prospective, observational study. BJOG 2016;123:1360-7.
- D’Hooghe T, Forman A. European accreditation of endometriosis centers of expertise? Gynecol Obstet Invest. 2013;76:1-3.
- Ceccaroni M, et al. Nerve-sparing laparoscopic eradication of deep endometriosis with segmental rectal and parametrial resection: the Negrar method. A single-center, prospective, clinical trial. SurgEndosc. 2012;26:2029-45.
- Abrao MS, et al. Deep endometriosis infiltrating the recto-sigmoid: critical factors to consider before management. Hum Reprod Update 2015; 21: 329-39.
- Malzoni M, et al. Feasibility and Safety of Laparoscopic-Assisted Bowel Segmental Resection for Deep Infiltrating Endometriosis: A Retrospective Cohort Study With Description of Technique. J Minim Invasive Gynecol. 2016 May-Jun;23(4):512-25.
- Seracchioli R, et al. Long-term cyclic and continuous oral contraceptive therapy and endometrioma recurrence: a randomized controlled trial. Fertil Steril. 2010 Jan;93(1):52-6.
- Roman H, Chanavaz-Lacheray I, et l’équipe Rouendométriose. Le centre expert de diagnostic et prise en charge multidisciplinaire de Rouen : une expérience pilote française. Gynecol Obstet Fertil Senol 2018 ; 46 :563-9.
- Ministère des Affaires Sociales et de la Santé. Femmes et Santé, Feuille de Route 2016. http://solidarites-sante.gouv.fr/IMG/pdf/femmes_et_sante.pdf
- Recommandations de bonne pratique, Prise en charge de l’endométriose. Gynecol Obstet Fertil Senol 2018.
- Chanavaz-Lacheray I., et al. Definition des Centres Experts en Endométriose. Gynécologie Obstétrique Fertilité & Sénologie. Fev 2018
- Golfier F., Chanavaz-Lacheray I., et al The definition of Endometriosis Expert Centres. J Gynecol Obstet Hum Reprod, Mars 2018
- Roman H, Chanavaz-Lacheray I, Forestier D, et al. Complications postopératoires immédiates dans un centre chirurgical multidisciplinaire exclusivement dédié à l’endométriose : une série de 491 patientes. Gynecol Obstet Fertil Senol. 2020;48(6):484-490. doi:10.1016/j.gofs.2020.03.009
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