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Table 1 Comparison of the RCTs, prospective and retrospective studies included in this literature review. Papers have been grouped by intervention/ comparator

From: Endometrial sampling in low-risk patients with abnormal uterine bleeding: a systematic review and meta-synthesis

Study Type of study Age of participants (mean ± SD) Intervention (n) vs Comparator (n) Outcome Pain Cost
Pipelle versus D&C +/− Hysterectomy
[23] Rauf et al. Pakistan 2014 RCT 46.3 ± 4.45 Pipelle (102) vs D&C (101) Adequacy
Pipelle 98%
D&C 100%
Pipelle less painful Pipelle cheaper
[46] Liu et al. China 2015 Prospective Sequential 43.6 Pipelle vs D&C (245) Adequacy
Pipelle 91.02%
D&C 92.24%
Pipelle less painful N/A
[47] Gungorduk et al. Turkey 2013 Prospective Pipelle: 49.8 ± 6.1
D&C: 48.2 ± 6.5
Pipelle + hysterectomy (78) vs D&C + hysterectomy (189) Adequacy
Pipelle 95%
D&C 96%
Concordance
Pipelle + hysterectomy 62%
D&C + hysterectomy 67%
Pipelle less painful Pipelle cheaper
[48] Kazandi et al.
Turkey
2012
Prospective Sequential 48 ± 9.43 Pipelle + hysterectomy
Vs
D&C + hysterectomy
(66)
Adequacy
Pipelle 93%
D&C 96%
Concordance
Pipelle and D&C 66%
Pipelle & hysterectomy 64%
Pipelle less painful Pipelle cheaper
[49] Demirkiran et al. Turkey 2012 Prospective 45.3 Pipelle + hysterectomy (212) vs D&C + hysterectomy
(161)
Adequacy
Pipelle 97%
D&C98%
Concordance
Pipelle and D&C 84%
Pipelle & hysterectomy 67%
D&C and hysterectomy 80%
Pipelle less painful Pipelle cheaper
[43] Sany et al. UK 2011 Retrospective ? Pipelle + hysterectomy vs D&C + hysterectomy (total 191) Concordance
Both techniques 78%
N/A N/A
[45] Daud et al. UK 2011 Retrospective 55.7 ± 11.4 Pipelle ± hysterectomy (75) vs D&C ± hysterectomy (220) Concordance
Pipelle + hysterectomy 76%
D&C + hysterectomy 86%
N/A N/A
[24] Fakhar et al. Pakistan 2008 Prospective Sequential 45.4 ± 7.2 Pipelle versus (D&C) (100) Adequacy
Pipelle 98%
D&C 100%
NPV for endometrial carcinoma
Pipelle 100%
N/A (both techniques under GA) Pipelle cheaper
[44] Huang et al. USA 2006 Retrospective + Letter ? Pipelle + hysterectomy (253) vs D&C + hysterectomy (93) Concordance
Pipelle and hysterectomy 93.8% (low grade cancer) & 99.2% (high grade cancer)
D&C and hysterectomy 97% (low grade cancer) & 100% (high grade cancer)
N/A N/A
[37] Macones et al. 2006
[66] Machado et al. Spain 2002 Retrospective Post-menopausal (68)
Pre- or peri-menopausal (100)
Pipelle (168) vs D&C (92) ± Hysterectomy (76) Accuracy
Sensitivity 84.2%
Specificity 99.1%
N/A N/A
[51] Kavak et al. Turkey 1996 Prospective 50.8 ± 7.8 Pipelle ± TVS (78) vs D&C (78) Concordance
Sensitivity: 73% (increased to 90% with TVS)
Specificity: 100%
N/A N/A
[50] Ben-Baruch et al. Israel 1993 Prospective Pre- and post-menopausal Pipelle (172) vs D&C (97) Adequacy
Pipelle 90.6%
D&C 68%
N/A N/A
[68] Sanam et al. Iran 2015 Prospective >  35 Pipelle (130) vs D&C (130) Concordance
Pipelle and D&C 94%
Adequacy
Pipelle 84.6%
D&C 90%
N/A Pipelle cheaper
[75] Gordon New Zealand 1999 Prospective 47.2 ± 1.8 Pipelle (100) vs D&C or hysterectomy (n =?) Adequacy
Pipelle 67%
N/A N/A
[69] Goldchmit et al. Israel 1993 Prospective Sequential 48.1 Pipelle and TVS vs D&C (176) Concordance
Pipelle & D&C 90% (increased to 92% with TVS)
N/A N/A
[52] Abdelazim et al. Turkey 2013 Prospective Sequential 44.5 Pipelle vs D&C (143) Adequacy
Pipelle 97.9%
D&C 100%
NPV for endometrial polyp
Pipelle 89.6%
N/A N/A
[72] Shams Pakistan 2012 Prospective Sequential 47.94 Pipelle vs D&C (50) N/A Pipelle less painful Pipelle cheaper
[53] Rezk et al. Egypt 2016 Prospective Pipelle: 47.2 ± 3.8
D&C: 46.9 ± 4.1
Pipelle (270) vs D&C (268) Adequacy
No difference (p˃0.05)
D&C less painful N/A
Pipelle versus Vabra +/− Hysterectomy
[54] Eddowes et al. UK 1990 Prospective Sequential 41.6 Pipelle vs Vabra Aspirator (100) Adequacy
Pipelle 88%
Vabra Aspirator 88%
Pipelle less painful Pipelle cheaper
[55] Naim et al. Malaysia 2007 RCT > 45 Pipelle (76) vs Vabra Aspirator (71) Adequacy
Pipelle 73.3%
Vabra 52.4%
N/A Pipellle cheaper
[28] Kaunitz et al. USA 1988 Prospective Sequential 46 Pipelle vs Vabra (56) Adequacy
Pipelle & Vabra 91%
Concordance
Pipelle & Vabra 89%
Pipelle less painful Pipelle cheaper
[56] Rodriguez et al. USA 1993 RCT ? Pipelle (12) vs Vabra (13) vs Hysterectomy (25) Surface being sampled:
Pipelle 4.2%
Vabra 41.6%
N/A N/A
Pipelle versus Tao Brush+/− Hysteroscopy
[30] Williams et al. UK 2008 RCT Sequential Moderate risk: 45.2 (SE 0.26) For moderate risk Pipelle (34)
Tao Brush (29)
Adequacy
Both techniques 84%
No significant difference for premenopausal
Tao Brush less painful N/A
[57] Critchley et al. UK 2004 RCT Moderate risk: pre-menopausal ˃40 or < 40 with risk for endometrial cancer
Low risk
Pipelle vs Tao Brush
Moderate risk
(Total 326)
Low risk (Total 157)
± hysteroscopy ± TVS
Successful completion of investigation:
Pipelle 85%
Adequacy of sample with Pipelle:
Moderate risk 79%
Tao Brush less painful than Pipelle Minimal difference
[58] Yang et al. USA 2003 Prospective Sequential 24–86 Pipelle (79) vs Tao Brush (79) Factors affecting sensitivity: tumour size, type, location within the uterus, sampling mechanism and preparation method N/A N/A
[59] Del Priore et al. USA 2001 RCT Sequential Pre-menopausal: 46
Post-menopausal: 61
Tao Brush vs Pipelle (50) Sensitivity:
Pipelle 86%
Tao Brush 95.5%
Specificity:
Both 100%
N/A Tao Brush cheaper than D&C
[60] Yang et al. USA 2000 Prospective Sequential 58 Tao Brush vs Tao Brush + Pipelle (25) Adequacy
Tao Brush 98%
Pipelle 88%
Tao Brush less painful Comparable
Pipelle versus Novak
[40] Henig et al. USA 1989 RCT Pre-menopausal Pipelle (50) Vs Novak (50) Adequacy
Pipelle 94%
Novak 98%
Better tolerance with Pipelle N/A
[26] Stovall et al. USA 1991 RCT Pipelle: 40
Novak: 44
Pipelle (149) vs Novak (126) Adequacy
Pipelle 87.2%
Novak 90.5%
Pipelle less painful Novak might be cheaper
[61] Silver et al. USA 1991 RCT Sequential 28–76 1st Pipelle then Novak (26) vs 1st Novak then Pipelle (29) Adequacy Similar Pipelle less painful N/A
Pipelle versus Hysterectomy
[67] Guido et al. USA 1995 Prospective Sequential 61 Pipelle vs Hysterectomy
(71)
Adequacy
Pipelle 97%
Concordance
Pipelle & hysterectomy 83%
N/A N/A
[42] Ferry et al. UK 1993 Prospective Sequential ? Pipelle vs Hysterectomy (37) Concordance
Pipelle & hysterectomy 67%
N/A N/A
[41] G Zorlu et al. Turkey 1994 Prospective Sequential 51 Pipelle vs Hysterectomy (26) Concordance
Pipelle & hysterectomy 95%
Mild pain and discomfort with Pipelle N/A
Pipelle versus Explora +/− Accurette
[62] Leclair et al. USA 2011 RCT Pipelle: 45.2 ± 7.3
Explora: 46.1 ± 7.7
Pipelle (37) vs
Explora (32)
Adequacy
Pipelle 91%
Explora 97%
No differences seen N/A
[32] Lipscomb et al. USA 1994 RCT N/A
Pre- and post-menopausal
Pipelle (85) vs Accurette (81) vs Explora (82) Adequacy
Pipelle 85.2%
Accurette 72.5%
Explora 85.4%
No significant difference in pain score N/A
Pipelle versus Infant Feeding Tube (IFT)
[63] Bhide et al. UK 2007 Prospective ? Pipelle (29) vs IFT (31) Adequacy
Pipelle 73%
IFT 71%
Less pain with IFT N/A
Pipelle Mark 2 versus Pipelle Mark 2 + hysteroscopy
[71] Polena et al. France 2006 Prospective
Sequential
50 Pipelle Mark 2 vs Pipelle Mark 2 ± hysteroscopy (97) Adequacy of Pipelle Mark 2
88.7%
No difference with conventional Pipelle Slightly more expensive than conventional Pipelle
Pipelle versus Tis-u-Trap
[27] Koonings et al. USA 1990 RCT Pipelle: 42.9
Tis-u-trap: 42.3
Pipelle + hysterectomy (74) vs Tis-u-trap + hysterectomy (75) Adequacy
Pipelle 87.8%
Tis-u-trap 84%
Concordance
Pipelle & hysterectomy 85%
Tis-u-trap & hysterectomy 92%
N/A Pipelle cheaper
Pipelle versus Endorette
[29] Moberger et al. Sweden 1998 RCT Sequential 57.5 ± 11.5 Pipelle vs Endorette
(152)
Adequacy and concordance
No difference
No significant difference N/A
Pipelle versus Cytospat +/− Hysterectomy
[31] Antoni et al. Spain 1996 RCT 48.6 ± 9 Pipelle ± hysterectomy or D&C (191) vs Cytospat ± hysterectomy or D&C (174) Adequacy
Pipelle 75%
Cytospat 76%
Concordance
Pipelle: Benign 84%, Hyperplasia 71%, Malignancy 60%
Cytospat: Benign 82%, Hyperplasia 60%, Malignancy 60%
Better tolerance for Pipelle Pipelle cheaper
Pipelle versus D&C +/− Hysteroscopy +/− TV US
[85] Tahir et al. UK 1999 RCT 35 Inpatient: Hysteroscopy & D&C (200) vs Outpatient: Pipelle +/− TV US +/− Hysteroscpy (200) Adequacy
No difference
Concordance
Inpatient: 100&
Outpatient: 82&
More pain in outpatient N/A
Others
[73] Trolice et al. USA 2000 RCT Anaesthesia for Pipelle Lidocaine: 42.1 ± 11.9/ Saline: 44.9 ± 12.5 Lidocaine (19) vs Saline (22) Significant reduction of pain with lidocaine Less pain with intervention N/A
[34] Cornier France 1984 Brief communication Mostly pre-menopausal Pipelle (250)
No control
Useful for histologic dating of the endometrium Little discomfort Low cost
[74] Frishman USA 1990 Letter in response to study [27] N/A Pipelle versus Tis-u-Trap N/A N/A Pipelle cheaper
[38] Mc Cluggage Northern Ireland 2006 Review N/A Pipelle versus other ES Difficulties of processing outpatient ES samples N/A N/A
[79] Van Den Bosch Belgium 2005 Prospective sequential Pre-menopausal: 41.6 ± 8.7
Post-menopausal: 59 ± 9.9
US before and after Pipelle (99) Thickness of the endometrium
ET on average 0.4 mm less after performing Pipelle
N/A N/A
[76] Brandner et al. Germany 2000 Review N/A N/A Progression of endometrial lesions (potential limitations for ES) N/A N/A
[80] Dijkhuizen et al. The Netherlands 2000 Meta-analysis 39 studies including 7914 patients Different ES Pipelle is superior to other ES for diagnosing cancer/ hyperplasia N/A N/A
[25] Cooper et al. USA 2000 Review N/A N/A Directed biopsy with Hysteroscopy: most accurate ES (not for primary care) N/A N/A
[14] Farquhar et al. New Zealand 1996 Survey 68 replies from O&G consultants (48% of all contestants) N/A Management of menorrhagia in primary care N/A N/A
[78] Youssif et al. Australia 1995 Review N/A N/A Effectiveness and safety of Pipelle N/A N/A
[77] Dantas et al. Brazil 1994 Letter Nurses vs doctors performing Pipelle N/A Adequacy No difference N/A N/A
[82] Clark et al. UK 2002 Systematic review and meta-analysis Mixed pre- (21%) and pos-tmenopausal (79%) Pipelle vs other outpatient techniques Likelihood ratio of endometrial cancer when Pipelle is:
-ve: 0.1
+ve: 64.6
N/A N/A
[86] Ahonkallio et al. Finland 2009 Prospective Range 47–52 Post ablation Pipelle (57) Adequacy
29% failure If
endometrium < 5 mm
5% failure if endometrium > 5 mm
N/A N/A
[81] Du et al. China 2016 Review N/A N/A Most appropriate ES devices for endometrial lesions Little discomfort N/A
[64] Masood et al. Pakistan 2015 Cross sectional Pre- and post-menopausal 35–48 Pipelle (126) vs no comparator Adequacy
Pipelle 96.82%
N/A Cost-effective
[39] Seamark UK 1998 Prospective ≥40
42–74
Primary care population
Pipelle (38) vs no comparator Adequacy
Pipelle 76%
N/A N/A
[70]Seto UK 2016 Retrospective Pre-menopausal 46.1 ± 4.6
Post-menopausal
57.2 ± 8.1
Pipelle against hysteroscopy Positive predictive value for endometrial polyp
Pipelle (pre-menopausal) 53.7%
N/A N/A
[65] Piatek et al. Poland 2016 Retrospective Pre- and post-menopausal Pipelle (312) vs no comparator Adequacy
83.01%
N/A N/A
  1. ES Endometrial sampling, AUB Abnormal uterine bleeding, RCT Randomized controlled trials, US Transvaginal ultrasound, N/A Non-applicable,? Unknown