MAURICIO SIMOES ABRAO

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Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina - Docente
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  • article 46 Citação(ões) na Scopus
    Consensus on Recording Deep Endometriosis Surgery: the CORDES statement(aEuro)
    (2016) VANHIE, A.; MEULEMAN, C.; TOMASSETTI, C.; TIMMERMAN, D.; D'HOORE, A.; WOLTHUIS, A.; CLEYNENBREUGEL, B. Van; DANCET, E.; BROECK, U. Van den; TSALTAS, J.; RENNER, S. P.; EBERT, A. D.; CARMONA, F.; ABBOTT, J.; STEPNIEWSKA, A.; TAYLOR, H.; SARIDOGAN, E.; MUELLER, M.; KECKSTEIN, J.; PLUCHINO, N.; JANIK, G.; ZUPI, E.; MINELLI, L.; COOPER, M.; DUNSELMAN, G.; KOH, C.; ABRAO, M.; CHAPRON, C.; D'HOOGHE, T.
    Which essential items should be recorded before, during and after endometriosis surgery and in clinical outcome based surgical trials in patients with deep endometriosis (DE)? A DE surgical sheet (DESS) was developed for standardized reporting of the surgical treatment of DE and an international expert consensus proposal on relevant items that should be recorded in surgical outcome trials in women with DE. Surgery is an important treatment for symptomatic DE. So far, data have been reported in such a way that comparison of different surgical techniques is impossible. Therefore, we present an international expert proposal for standardized reporting of surgical treatment and surgical outcome trials in women with DE. International expert consensus based on a systematic review of literature. Taking into account recommendations from Consolidated Standards of Reporting Trials (CONSORT), the Innovation Development Exploration Assessment and Long-term Study (IDEAL), the Initiative on Methods, Measurement and Pain Assessment in Clinical trials (IMMPACT) and the World Endometriosis Research Foundation Phenome and Biobanking Harmonisation Project (WERF EPHect), a systematic literature review on surgical treatment of DE was performed and resulted in a proposal for standardized reporting, adapted by contributions from eight members of the multidisciplinary Leuven University Hospitals Endometriosis Care Program, from 18 international experts and from audience feedback during three international meetings. We have developed the DESS to record in detail the surgical procedures for DE, and an international consensus on pre-, intra- and post-operative data that should be recorded in surgical outcome trials on DE. The recommendations in this paper represent a consensus among international experts based on a systematic review of the literature. For several items and recommendations, high-quality RCTs were not available. Further research is needed to validate and evaluate the recommendations presented here. This international expert consensus for standardized reporting of surgical treatment in women with DE, based on a systematic literature review and international consensus, can be used as a guideline to record and report surgical management of patients with DE and as a guideline to design, execute, interpret and compare clinical trials in this patient population. None of the authors received funding for the development of this paper. M.A. reports personal fees and non-financial support from Bayer Pharma outside the submitted work; H.T. reports a grant from Pfizer and personal fees for being on the advisory board of Perrigo, Abbvie, Allergan and SPD. N/A.
  • article 19 Citação(ões) na Scopus
    Endometriosis Classification, Staging and Reporting Systems: A Review on the Road to a Universally Accepted Endometriosis Classification † ‡
    (2021) VERMEULEN, N.; ABRAO, M. S.; EINARSSON, J. I.; HORNE, A. W.; JOHNSON, N. P.; LEE, T. T. M.; MISSMER, S.; PETROZZA, J.; TOMASSETTI, C.; ZONDERVAN, K. T.; GRIMBIZIS, G.; WILDE, R. L. De; WES, ESGE International working group of AAGL ESHRE and
    Objective: In the field of endometriosis, several classification, staging and reporting systems have been developed. Which endometriosis classification, staging and reporting systems have been published and validated for use in clinical practice? Data sources: A systematic PUBMED literature search was performed. Data were extracted and summarized. Methods of study selection: na Tabulation, integration and results: Twenty-two endometriosis classification, staging and reporting systems have been published between 1973 and 2021, each developed for specific, and different, purposes. There still is no international agreement on how to describe the disease. Studies evaluating the different systems are summarized showing a discrepancy between the intended and the evaluated purpose, and a general lack of validation data confirming a correlation with pain symptoms or quality of life for any of the current systems. A few studies confirm the value of the ENZIAN system for surgical description of deep endometriosis. With regards to infertility, the endometriosis fertility index has been confirmed valid for its intended purpose. Conclusion: Of the 22 endometriosis classification, staging and reporting systems identified in this historical overview, only a few have been evaluated for the purpose for which they were developed. The literature search was limited to PUBMED. Unpublished classification, staging or reporting systems, or those published in books were not considered. It can be concluded that there is no international agreement on how to describe endometriosis or how to classify it, and that most classification/staging systems show no or very little correlation with patient outcomes. This overview of existing systems is a first step in working towards a universally accepted endometriosis classification. © 2021
  • article
    Endometriosis classification systems: an international survey to map current knowledge and uptake
    (2022) ZONDERVAN, Krina T.; MISSMER, Stacey; ABRAO, Mauricio S.; I, Jon Einarsson; HORNE, Andrew W.; JOHNSON, Neil P.; LEE, Ted T. M.; PETROZZA, John; TOMASSETTI, Carla; VERMEULEN, Nathalie; GRIMBIZIS, Grigoris; WILDE, Rudy L. de
    Background: In the field of endometriosis, several classification, staging and reporting systems have been developed and published, but there are no data on the uptake of these systems in clinical practice. Objectives: The objective of the current study was to examine whether clinicians routinely use the existing endometriosis classification systems, which system do they use and what are the clinicians' motivations? Materials and Methods: A cross-sectional study was performed to gather data on the current use of endometriosis classification systems, problems encountered and interest in a new simple surgical descriptive system for endometriosis. Of particular focus were three systems most commonly used: the Revised American Society for Reproductive Medicine (rASRM) classification, the Endometriosis Fertility Index (EFI), and the ENZIAN classification. Data were analysed by SPSS. A survey was designed using the online SurveyMonkey tool consisting of 11 questions concerning three domains-participants' background, existing classification systems and intentions with regards to a new classification system for endometriosis. Replies were collected between 15 May and 1 July 2020. Main outcome measures: Uptake, feedback and future intentions. Results: The final dataset included the replies of 1178 clinicians, including surgeons, gynaecologists, reproductive endocrinologists, fertility specialists and sonographers, all managing women with endometriosis in their clinical practice. Overall, 75.5% of the professionals indicate that they currently use a classification system for endometriosis. The rASRM classification system was the best known and used system, the EFI system and ENZIAN system were known by a majority of the professionals but used by only a minority. The lack of clinical relevance was most often selected as a problem with using any system. The findings of the survey suggest that clinicians worldwide are open to using a new classification system for endometriosis that can achieve standardised reporting, and is clinically relevant and simple. Conclusions: Even with a high uptake of the existing endometriosis classification systems (rASRM, ENZIAN and EFI), most clinicians managing endometriosis would like a new simple surgical descriptive system for endometriosis. What is new? The findings therefore support future initiatives for the development of a new descriptive system for endometriosis and provide information on user expectations and conditions for universal uptake of such a system.
  • article 45 Citação(ões) na Scopus
    An international terminology for endometriosis, 2021
    (2021) TOMASSETTI, Carla; JOHNSON, Neil P.; PETROZZA, John; ABRAO, Mauricio S.; I, Jon Einarsson; HORNE, Andrew W.; LEE, Ted T. M.; MISSMER, Stacey; VERMEULEN, Nathalie; ZONDERVAN, Krina T.; GRIMBIZIS, Grigoris; WILDE, Rudy Leon De
    STUDY QUESTION: Can a set of terms and definitions be prepared on endometriosis that would be the basis for standardization in disease description, classification and research? SUMMARY ANSWER: The current paper outlines a list of 49 terms and definitions in the field of endometriosis. WHAT IS KNOWN ALREADY: Different classification systems have been developed for endometriosis, using different definitions for the disease, the different subtypes, symptoms and treatments. In addition, an International Glossary on Infertility and Fertility Care was published in 2017 by the International Committee for Monitoring Assisted Reproductive Technologies (ICMART) in collaboration with other organisations. STUDY DESIGN, SIZE, DURATION: An international working group convened over the development of a classification or descriptive system for endometriosis. As a basis for such a system, a terminology for endometriosis was considered a condition sine qua non. The working group listed a number of terms relevant to be included in the terminology, documented currently used and published definitions, and discussed and adapted them until consensus was reached within the working group. Following stakeholder review, further terms were added, and definitions further clarified. PARTICIPANTS/MATERIALS, SETTING, METHODS: Although definitions were collected through published literature, the final set of terms and definitions is to be considered consensus-based. After finalization of the first draft, the members of the international societies and other stakeholders were consulted for feedback and comments, which led to further adaptations. MAIN RESULTS AND THE ROLE OF CHANCE: A list of 49 terms and definitions in the field of endometriosis is presented, including a definition for endometriosis and its subtypes, different locations, interventions, symptoms and outcomes. Endometriosis is defined as a disease characterized by the presence of endometrium-like epithelium and/or stroma outside the endometrium and myometrium, usually with an associated inflammatory process. LIMITATIONS, REASONS FOR CAUTION: Future research may require further refinement of the presented definitions. WIDER IMPLICATIONS OF THE FINDINGS: The application of the defined terms aims to facilitate harmonization in endometriosis research and clinical practice.
  • article 6 Citação(ões) na Scopus
    Endometriosis Classification Systems: An International Survey to Map Current Knowledge and Uptake
    (2022) ZONDERVAN, Krina T.; MISSMER, Stacey; ABRAO, Mauricio S.; I, Jon Einarsson; HORNE, Andrew W.; JOHNSON, Neil P.; LEE, Ted T. M.; PETROZZA, John; TOMASSETTI, Carla; VERMEULEN, Nathalie; GRIMBIZIS, Grigoris; WILDE, Rudy Leon De
    Objective: In the field of endometriosis, several classification, staging and reporting systems have been developed, but do clinicians routinely use these classification systems, which system do they use and what are the clinicians' motivations? Data sources: A cross-sectional study was performed to gather data on the current use of endometriosis classification systems, problems encountered and interest in a new simple surgical descriptive system for endometriosis. Of particular focus were three systems most commonly used: the Revised American Society for Reproductive Medicine (rASRM) classification, the Endometriosis Fertility Index (EFI), and the ENZIAN classification. Data were analysed by SPSS. A survey was designed using the online SurveyMonkey tool consisting of 11 questions concerning three domains-participants background, existing classification systems and intentions with regards to a new classification system for endometriosis. Replies were collected between 15 May and 1 July 2020. Methods of study selection: na Tabulation, integration and results: The final dataset included the replies of 1178 clinicians, including surgeons, gynecologists, reproductive endocrinologists, fertility specialists and sonographers, all managing women with endometriosis in their clinical practice. Overall, 75.5% of the professionals indicate that they currently use a classification system for endometriosis. The rASRM classification system was the best known and used system, the EFI system and ENZIAN system were known by a majority of the professionals but used by only a minority. The lack of clinical relevance was most often selected as a problem with using any system. The findings of the survey suggest that clinicians worldwide are open to using a new classification system for endometriosis that can achieve standardized reporting, and is clinically relevant and simple. The findings therefore support future initiatives for the development of a new descriptive system for endometriosis and provide information on user expectations and conditions for universal uptake of such a system. Conclusion: Even with a high uptake of the existing endometriosis classification systems (rASRM, ENZIAN and EFI), most clinicians managing endometriosis would like a new simple surgical descriptive system for endometriosis. (C) 2022 Published by Elsevier Inc. on behalf of AAGL.
  • article 2 Citação(ões) na Scopus
    Endometriosis classification systems: an international survey to map current knowledge and uptake(dagger)(double dagger)
    (2022) ZONDERVAN, Krina T.; MISSMER, Stacey; ABRAO, Mauricio S.; I, Jon Einarsson; HORNE, Andrew W.; JOHNSON, Neil P.; LEE, Ted T. M.; PETROZZA, John; TOMASSETTI, Carla; VERMEULEN, Nathalie; GRIMBIZIS, Grigoris; WILDE, Rudy Leon De
    STUDY QUESTION Which classification system for endometriosis do clinicians use most frequently, and why? SUMMARY ANSWER Even with a high uptake of the three existing endometriosis classification systems, most clinicians managing endometriosis would like a new simple surgical descriptive system for endometriosis. WHAT IS KNOWN ALREADY In the field of endometriosis, several classifications, staging and reporting systems have been developed and published, but there are no data on the uptake of these systems in clinical practice. STUDY DESIGN, SIZE, DURATION A survey was designed using the online SurveyMonkey tool consisting of 11 questions concerning three domains-participants background, existing classification systems and intentions with regards to a new classification system for endometriosis. Replies were collected between 15 May and 1 July 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS A cross-sectional study was performed to gather data on the current use of endometriosis classification systems, problems encountered and interest in a new simple surgical descriptive system for endometriosis. The particular focus was on the three systems most commonly used: the Revised American Society for Reproductive Medicine (rASRM) classification, the endometriosis fertility index (EFI), and the ENZIAN classification. Data were analysed to detect statistically significant differences among user groups. MAIN RESULTS AND THE ROLE OF CHANCE The final dataset included the replies of 1178 clinicians, including surgeons, gynaecologists, reproductive endocrinologists, fertility specialists and sonographers, all managing women with endometriosis in their clinical practice. Overall, 75.5% of the professionals indicate that they currently use a classification system for endometriosis. The rASRM classification system was the best known and used system, while the EFI system and ENZIAN system were known by a majority of the professionals but used by only a minority. The lack of clinical relevance was most often selected as a problem with using any system. The vast majority of respondents replied positively to the question on whether they would use a simple surgical descriptive system available for endometriosis, if available. LIMITATIONS, REASONS FOR CAUTION While the total number of respondents was acceptable, some regions/professions were not sufficiently represented to draw conclusions. WIDER IMPLICATIONS OF THE FINDINGS The findings of the survey suggest that clinicians worldwide are open to using a new classification system for endometriosis that can achieve standardized reporting and is clinically relevant and simple. The findings therefore support future initiatives for the development of a new descriptive system for endometriosis and provide information on user expectations and conditions for universal uptake of such a system. STUDY FUNDING/COMPETING INTEREST(S) The meetings and activities of the working group were funded by the American Association of Gynecologic Laparoscopists, European Society for Gynecological Endoscopy, ESHRE and World Endometriosis Society. A.W.H. reports grant funding from the MRC, NIHR, CSO, Roche Diagnostics, Astra Zeneca, Ferring, Charles Wolfson Charitable Trust, Standard Life, and consultancy fees from Roche Diagnostics, AbbVie, Nordic Pharma and Ferring, outside the submitted work. In addition, A.W.H. has a patent Serum biomarker for endometriosis pending. He is Chair of TSC for STOP-OHSS and CERM trials and Chair of RCOG Academic Board 2018-2021. M.A. reports being member of the executive board and vice president of AAGL. N.P.J. reports personal fees from Abbott, Guerbet, Myovant Sciences, Vifor Pharma, Roche Diagnostics outside the submitted work; he is also President of the World Endometriosis Society and chair of the trust board. S.M. reports grants from AbbVie, DoD, NIH and Marriot Family Foundation, honoraria from University British Columbia and WERF, support for speaking at conferences (ESHRE, CanSAGE, Endometriosis UK, UEARS, IFFS, IASP, National Endometriosis Network UK) participation on Advisory Boards from AbbVie and Roche, outside the submitted work. She also discloses having a leadership or fiduciary role in SWHR, WERF, WES, ASRM and ESHRE. C.T. reports grants, consulting and speakers' fees non-financial support and other from Merck SA, non-financial support and other consulting fees from Gedeon Richter and Nordic Pharma, and support for meeting attendance non-financial support from Ferring Pharmaceuticals, outside the submitted work and without private revenue. K.T.Z. reports grants from Bayer Healthcare, MDNA Life Sciences, Volition Rx, and Evotec (Lab282-Partnership programme with Oxford University), non-financial support from AbbVie Ltd, all outside the submitted work; and is a Board member (Secretary) of the World Endometriosis Society and World Endometriosis Research Foundation. J.P. reports personal fees from Hologic, Inc., outside the submitted work; he is also a member of the executive boards of ASRM and SRS. The other authors had nothing to disclose.
  • article
    An International Terminology for Endometriosis, 2021
    (2021) TOMASSETTI, C.; JOHNSON, N. P.; PETROZZA, J.; ABRAO, M. S.; I, J. Einarsson; HORNE, A. W.; LEE, T. T. M.; MISSMER, S.; VERMEULEN, N.; ZONDERVAN, K. T.; GRIMBIZIS, G.; WILDE, R. L. De
    Background: Different classification systems have been developed for endometriosis, using different definitions for the disease, the different subtypes, symptoms and treatments. In addition, an International Glossary on Infertility and Fertility Care was published in 2017 by the International Committee for Monitoring Assisted Reproductive Technologies (ICMART) in collaboration with other organisations. An international working group convened over the development of a classification or descriptive system for endometriosis. As a basis for such system, a terminology for endometriosis was considered a condition sine qua non. Objectives: The aim of the current paper is to develop a set of terms and definitions on endometriosis that would be the basis for standardisation in disease description, classification and research. Materials and Methods: The working group listed a number of terms relevant to be included in the terminology, documented currently used and published definitions, and discussed and adapted them until consensus was reached within the working group. Following stakeholder review, further terms were added, and definitions further clarified. Although definitions were collected through published literature, the final set of terms and definitions is to be considered consensus-based. After finalisation of the first draft, the members of the international societies and other stakeholders were consulted for feedback and comments, which led to further adaptations. Results: A list of 49 terms and definitions in the field of endometriosis is presented, including a definition for endometriosis and its subtypes, different locations, interventions, symptoms and outcomes. Endometriosis is defined as a disease characterised by the presence of endometrium-like epithelium and/or stroma outside the endometrium and myometrium, usually with an associated inflammatory process. Conclusions: The current paper outlines a list of 49 terms and definitions in the field of endometriosis. The application of the defined terms aims to facilitate harmonisation in endometriosis research and clinical practice. Future research may require further refinement of the presented definitions. What is new? A consensus based international terminology for endometriosis for clinical and research use.
  • article 0 Citação(ões) na Scopus
    Reply: Should we also work on an international informed consent for endometriosis surgery?
    (2017) VANHIE, A.; MEULEMAN, C.; TOMASSETTI, C.; TIMMERMAN, D.; D'HOORE, A.; WOLTHUIS, A.; CLEYNENBREUGEL, B. Van; DANCET, E.; BROECK, U. Van den; TSALTAS, J.; RENNER, S. P.; EBERT, A. D.; CARMONA, F.; ABBOTT, J.; STEPNIEWSKA, A.; TAYLOR, H.; SARIDOGAN, E.; MUELLER, M.; KECKSTEIN, J.; PLUCHINO, N.; ZUPI, E.; DUNSELMAN, G.; ABRAO, M. S.; CHAPRON, C.; D'HOOGHE, T.
  • article 49 Citação(ões) na Scopus
    Strengths and limitations of diagnostic tools for endometriosis and relevance in diagnostic test accuracy research
    (2022) PASCOAL, E.; WESSELS, J. M.; AAS-ENG, M. K.; ABRAO, M. S.; CONDOUS, G.; JURKOVIC, D.; ESPADA, M.; EXACOUSTOS, C.; FERRERO, S.; GUERRIERO, S.; HUDELIST, G.; MALZONI, M.; REID, S.; TANG, S.; TOMASSETTI, C.; SINGH, S. S.; BOSCH, T. van den; LEONARDI, M.
    Endometriosis is a chronic systemic disease that can cause pain, infertility and reduced quality of life. Diagnosing endometriosis remains challenging, which yields diagnostic delays for patients. Research on diagnostic test accuracy in endometriosis can be difficult due to verification bias, as not all patients with endometriosis undergo definitive diagnostic testing. The purpose of this State-of-the-Art Review is to provide a comprehensive update on the strengths and limitations of the diagnostic modalities used in endometriosis and discuss the relevance of diagnostic test accuracy research pertaining to each. We performed a comprehensive literature review of the following methods: clinical assessment including history and physical examination, biomarkers, diagnostic imaging, surgical diagnosis and histopathology. Our review suggests that, although non-invasive diagnostic methods, such as clinical assessment, ultrasound and magnetic resonance imaging, do not yet qualify formally as replacement tests for surgery in diagnosing all subtypes of endometriosis, they are likely to be appropriate for advanced stages of endometriosis. We also demonstrate in our review that all methods have strengths and limitations, leading to our conclusion that there should not be a single gold-standard diagnostic method for endometriosis, but rather, multiple accepted diagnostic methods appropriate for different circumstances. (c) 2022 International Society of Ultrasound in Obstetrics and Gynecology.
  • article 46 Citação(ões) na Scopus
    An International Terminology for Endometriosis, 2021
    (2021) TOMASSETTI, C.; JOHNSON, N. P.; PETROZZA, J.; ABRAO, M. S.; EINARSSON, J. I.; HORNE, A. W.; LEE, T. T. M.; MISSMER, S.; VERMEULEN, N.; ZONDERVAN, K. T.; GRIMBIZIS, G.; WILDE, R. L. De; WES, ESGE International working group of AAGL ESHRE and
    Objective: Different classification systems have been developed for endometriosis, using different definitions for the disease, the different subtypes, symptoms and treatments. In addition, an International Glossary on Infertility and Fertility Care has been published in 2017 by the International Committee for Monitoring Assisted Reproductive Technologies (ICMART) in collaboration with other organisations. An international working group convened over the development of a classification or descriptive system for endometriosis. As a basis for such system, a terminology for endometriosis was considered a condition sine qua non. The aim of the current study was to develop a set of terms and definitions be prepared on endometriosis that would be the basis for standardization in disease description, classification and research. Data Sources: The working group listed a number of terms relevant to be included in the terminology, documented currently used and published definitions, and discussed and adapted them until consensus was reached within the working group. Following stakeholder review, further terms were added, and definitions further clarified. Although definitions were collected through published literature, the final set of terms and definitions is to be considered consensus-based. After finalization of the first draft, the members of the international societies and other stakeholders were consulted for feedback and comments, which lead to further adaptations. Methods of Study Selection: na Tabulation, Integration, and Results: A list of 49 terms and definitions in the field of endometriosis is presented, including a definition for endometriosis and its subtypes, different locations, interventions, symptoms and outcomes. Endometriosis is defined as a disease characterized by the presence of endometrium-like epithelium and/or stroma outside the endometrium and myometrium, usually with an associated inflammatory process. Conclusion: The current paper outlines a list of 49 terms and definitions in the field of endometriosis. The application of the defined terms aims to facilitate harmonization in endometriosis research and clinical practice. Future research may require further refinement of the presented definitions. © 2021 AAGL