A Comparative Analysis of the Pipelle Device and Conventional Dilatation and Curettage as Investigative Tools for Abnormal Uterine Bleeding: Assessing Sample Adequacy and Patient Perspectives: A Prospective Observational Cohort Study

A BSTRACT Introduction: The primary objective of evaluating abnormal uterine bleeding is to exclude intrauterine abnormalities, particularly endometrial hyperplasia and carcinoma. Therefore, all individuals over the age of 40 need to undergo endometrial sampling for histopathological evaluation before any definitive management strategies. Endometrial sampling may be conducted using various techniques, including dilatation and curettage (D and C) with metal curettes, such as Novak and Kevorkian, or through endometrial aspiration utilizing flexible instruments like the Pipelle aspirator. Despite the availability of the Pipelle, numerous medical centers continue to prefer D and C under anesthesia. A study at a tertiary medical center compared the adequacy of samples and the detection of malignancies between the Pipelle aspirator and D and C. This study further evaluated pain scores and the overall acceptability of both procedures among participants, providing valuable insights into their effectiveness and patient experience. Methodology: A comparative study was undertaken to evaluate the adequacy of samples for microscopic examination. This study compared outpatient endometrial sampling conducted with a Pipelle device to D and C performed under anesthesia. Furthermore, the assessment included the evaluation of postprocedure pain and patient satisfaction. Results: The analysis concluded no significant differences in sample adequacy between the two techniques examined. Women who underwent endometrial biopsies with anesthesia reported experiencing reduced levels of pain and expressed greater satisfaction with the procedure. Conclusion: While outpatient endometrial sampling utilizing the Pipelle aspirator is a feasible option in low-resource settings, it is essential to consider postoperative pain and patient satisfaction when evaluating practices in high-resource environments.