Microwave therapy for cervical ectropion

In western countries, cervical ectropion or erosion caused by the movement of columnar epithelium onto the vaginal portion of the cervix is considered a normal physiological process not requiring intervention. In China, however, cervical ectropion is considered as one of the most common types of chronic cervicitis and is often treated. One of the topical treatments widely used is microwave tissue coagulation (MTC). From Chinese databases, the authors identified 131 potential randomised controlled clinical trials (RCTs) that compared microwave therapy to no treatment or other treatments. Only three of these studies involving a total of 540 participants were identified as RCTs. Two studies (420 participants) compared MTC versus laser, and one study (120 participants) compared MTC with an interferon-alpha suppository. The follow-up period of the RCTs was adequate. None of the studies assessed relief of symptoms or quality of life and satisfaction, which are very important to women. The authors of the review considered that they could not answer the review question about the appropriate use of microwave therapy as only these three low quality RCTs were found. Although the trials showed improved appearance of the cervix with microwave treatment compared with the control therapy, it was not possible to ascertain whether the women were symptomatic before treatment. The review protocol also required participants to be symptomatic with mucopurulent discharge or to have contact bleeding before treatment. At present, intervention for inflammatory cervical ectropion is still controversial.

Authors' conclusions: 

There were no RCTs in symptomatic women with cervical ectropion comparing microwave therapy with another treatment or no treatment. Although microwave therapy improved the appearance of the cervix compared with both laser and interferon-alpha suppository therapy, any other benefit for the women was not clear.

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Background: 

In western medicine, cervical ectropion is considered as a normal finding that does not require treatment despite the red and inflamed appearance of the cervix. However, cervical ectropion is considered as one of the most common types of chronic cervicitis in China. Topical treatments for cervical ectropion, including microwave tissue coagulation, are widely used in many hospitals in China they are considered likely to reduce the chances of development of abnormal metaplasia and infection.

Objectives: 

To compare the efficacy and potential side effects of microwave tissue coagulation with other interventions or no intervention in the treatment of cervical ectropion.

Search strategy: 

We searched The Cochrane Library, MEDLINE, EMBASE, Chinese Biomedical Literature Database (CBM), Chinese Medical Current Contents (CMCC), CAJ Full-text Database and the Chinese Scientific Journals Database. We also searched for related literature on the Internet with search engines such as Google and searched the reference lists of articles and handsearched relevant Chinese journals. The search of these databases was conducted from inception to May 2009.

Selection criteria: 

Only authentic randomised controlled trials (RCTs) were considered for inclusion.

Data collection and analysis: 

Two review authors independently interviewed the original authors of claimed RCTs published in China and then assessed the risk of bias of three RCTs and extracted data.

Main results: 

No studies were found that met the participant inclusion criteria of the protocol. One hundred and thirty-three studies were reported as RCTs, but only only three studies were identified as authentic RCTs. However, it was not possible to confirm that the participants were symptomatic prior to treatment. and the methodological quality of the three RCTs was generally low. No trial compared treatment to no intervention and most trials didn't assess relief of symptoms or quality of life and satisfaction, which are very important to women.

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