{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T16:39:18Z","timestamp":1786207158055,"version":"build-2736575974"},"reference-count":42,"publisher":"Galenos Yayinevi","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Facts Views Vis ObGyn"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:p>Background: Endometriosis is a common benign gynaecological disease that affects pelvic structures and causes adhesions. Endometriosis outside the pelvis exists but is rarer. Deep endometriosis may affect organs such as the urinary bladder, ureters, bowel and sacral roots. Adenomyosis (growth of endometrium in the myometrium, sometimes explained by disruption of the uterine junctional zone) frequently co-exists with deep endometriosis. Over the past decades, multiple attempts have been made to describe the anatomical extent of endometriosis. Out of approximately 20 classification systems suggested and published so far, three have gained widespread acceptance. These are the rASRM (American Society of Reproductive Medicine) classification, the Endometriosis Fertility Index (EFI) and the Enzian classification. Ideally, a classification system should be useful both for describing disease extent based on surgical findings and results of imaging methods (ultrasound, magnetic resonance imaging).\n\nObjectives: To highlight the advantages and disadvantages of the three classification systems.\n\nMethods: This is a narrative review based on selected publications and experience of the authors. We discuss the current literature on the use of the rASRM, EFI and Enzian classification systems for describing disease extent with imaging methods and for prediction of fertility, surgical complexity, and risk of surgical complications. We underline the need for one universally acceptable terminology to describe the extent of endometriosis.\n\nConclusions: A useful classification system for endometriosis should describe the sites and extent of the disease, be related to surgical complexity and to disease-associated symptoms, including subfertility and should satisfy needs of both, imaging specialists for pre-operative classification and surgeons. The need for such a system is obvious and is provided by the #Enzian classification. Future research is necessary to test its validity.<\/jats:p>","DOI":"10.52054\/fvvo.13.4.041","type":"journal-article","created":{"date-parts":[[2022,1,14]],"date-time":"2022-01-14T00:18:10Z","timestamp":1642119490000},"page":"331-338","source":"Crossref","is-referenced-by-count":51,"title":["What to choose and why to use \u2013 a critical review on the clinical relevance of rASRM, EFI and Enzian classifications of endometriosis"],"prefix":"10.52054","volume":"13","author":[{"given":"G","family":"Hudelist","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L","family":"Valentin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E","family":"Saridogan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G","family":"Condous","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Malzoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H","family":"Roman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Jurkovic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Keckstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2811","published-online":{"date-parts":[[2022,1]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Adamson GD. Endometriosis classification: an update. Curr Opin Obstet Gynecol 2011;23:213-20.","DOI":"10.1097\/GCO.0b013e328348a3ba"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Adamson GD, Pasta DJ. Endometriosis fertility index: the new, validated endometriosis staging system. Fertil Steril. 2010;94:1609-15.","DOI":"10.1016\/j.fertnstert.2009.09.035"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"American Society for Reproductive Medicine. Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril. 1997;67:817-21.","DOI":"10.1016\/s0015-0282(97)81391-x"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Andres MP, Borrelli GM, Abrao MS. Endometriosis classification according to pain symptoms: can the ASRM classification be improved? 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Past, present and future ultrasonographic techniques for analyzing ovarian masses. Womens Health (Lond). 2015b;11: 369-83.","DOI":"10.2217\/whe.15.11"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Guerriero S, Condous G, van den Bosch T et al. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol. 2016;48: 318-32.","DOI":"10.1016\/j.ultrasmedbio.2017.08.1404"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Haas D, Oppelt P, Shebl O et al. Enzian classification: does it correlate with clinical symptoms and the rASRM score? Acta Obstet Gynecol Scand 2013;92: 562-6.","DOI":"10.1111\/aogs.12118"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Haas D, Shebl O, Shamiyeh A, Oppelt P. The rASRM score and the Enzian classification for endometriosis: their strengths and weaknesses. Acta Obstet Gynecol Scand. 2013;92:3-7.","DOI":"10.1111\/aogs.12026"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Holland TK, Yazbek J, Cutner A et al. Value of transvaginal ultrasound in assessing severity of pelvic endometriosis. Ultrasound Obstet Gynecol. 2010;36:241-8.","DOI":"10.1002\/uog.7689"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Hudelist G ME, Dauser B, Nemeth Z et al. Comparison between sonography-based and surgical extent of deep endometriosis (DE) using the Enzian classification. Abstract Book European Endometriosis Congress, Prague 2019.","DOI":"10.1016\/j.jmig.2021.02.009"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Imboden S, Bollinger Y, Harma K et al. Predictive factors for voiding dysfunction after surgery for deep infiltrating endometriosis. 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Association between disease extent and pain symptoms in patients with deep infiltrating endometriosis. Reprod Biomed Online. 2019;39:845-51.","DOI":"10.1016\/j.rbmo.2019.06.006"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"Nicolaus K, Zschauer S, Brauer D et al. Extensive endometriosis surgery: rASRM and Enzian score independently relate to post-operative complication grade. Arch Gynecol Obstet 2020;301: 699-6.","DOI":"10.1007\/s00404-019-05425-0"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"Poupon C, Owen C, Arfi A et al. Nomogram predicting the likelihood of complications after surgery for deep endometriosis without bowel involvement. Eur J Obstet Gynecol Reprod Biol. 2019;3:100028.","DOI":"10.1016\/j.eurox.2019.100028"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"The American Fertility Society Classification of endometriosis. 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Reproductive performance, pain recurrence and disease relapse after conservative surgical treatment for endometriosis: the predictive value of the current classification system. Hum Reprod. 2006;21: 2679-85.","DOI":"10.1093\/humrep\/del230"},{"key":"ref40","doi-asserted-by":"publisher","unstructured":"Vercellini P, Fedele L, Aimi G et al. Association between endometriosis stage, lesion type, patient characteristics and severity of pelvic pain symptoms: a multivariate analysis of over 1000 patients. Hum Reprod. 2007;22:266-71.","DOI":"10.1093\/humrep\/del339"},{"key":"ref41","doi-asserted-by":"publisher","unstructured":"Williams JC, Burnett TL, Jones T et al. Association between kissing and retropositioned ovaries and severity of endometriosis: MR imaging evaluation. Abdom Radiol (NY). 2020;45:1637-44.","DOI":"10.1007\/s00261-019-02153-6"}],"container-title":["Facts, Views and Vision in ObGyn"],"original-title":[],"language":"en","deposited":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T05:55:19Z","timestamp":1739512519000},"score":1,"resource":{"primary":{"URL":"https:\/\/fvvo.eu\/articles\/doi\/FVVO.13.4.041"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":42,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,1]]},"published-print":{"date-parts":[[2021,12]]}},"URL":"https:\/\/doi.org\/10.52054\/fvvo.13.4.041","relation":{},"ISSN":["2684-4230","2032-0418"],"issn-type":[{"value":"2684-4230","type":"electronic"},{"value":"2032-0418","type":"print"}],"subject":[],"published":{"date-parts":[[2021,12]]}}}