Safety of ablation under question. (Late Complications Seen).

ASHLAND, ORE. -- Complications arising months to years after total or global rollerball endometrial ablation raise serious questions about the technique's long-term safety, including the "scary" possibility that women who have undergone the procedure may be vulnerable to asymptomatic endometrial cancer, according to Dr. Arthur M. McCausland of Sacramento.

Of 50 patients followed for 10 years after total rollerball endometrial ablation, 2 developed symptomatic cornual hematometras and 3 developed postablation tubal sterilization syndrome (PATSS), he said at the annual meeting of the Pacific Coast Obstetrical and Gynecological Society.

"At first, the technique seemed very safe. But as time passed, certain unique complications became evident," he said of total or global rollerball endometrial ablation, first performed in the late 1980s.

The rollerball technique removes the endometrium, exposing myometrium in much the same way that is seen with newer endometrial ablation techniques. The intrauterine cavity is then surrounded by raw myometrium.

"When you let your distention medium out, these [myometrium-lined intrauterine] walls collapse on each other and have a natural tendency to grow together, peripherally at first," he said. Eventually, the intrauterine cavity is reduced to a narrow, fibrotic tubular structure.

To demonstrate, he showed a slide depicting hysteroscopy results of a patient 1 year after total ablation. The intrauterine walls had grown together, obstructing the cornua. Unfortunately endometrial tissue persists in the cornua or fundus in as many as 95% of cases, according to MRI studies cited by Dr. McCausland.

"If any of these cells decide to turn to cancer, there could be obstructed bleeding and a delay in the diagnosis." Endometrial cancer is the most common gynecologic cancer, but it is usually diagnosed at a curable stage because of postmenopausal bleeding. Without that signal, he said, "I'm afraid the death rate could increase."