Cited by 234Endometriosis Research and TreatmentEndometrial and Cervical Cancer TreatmentsDiagnosis and treatment of tuberculosis

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ENZIAN-Score, eine Klassifikation der tief infiltrierenden Endometriose

Tuttlies, F., Keckstein, J., Ulrich, U., Possover, M., Schweppe, K., Wustlich, M., Buchweitz, O., Greb, R., Kandolf, O., Mangold, R., Masetti, W., Neis, K., Rauter, G., Reeka, N., Richter, O., Schindler, A., Sillem, M., Terruhn, V., Tinneberg, H.·2005·Zentralblatt für Gynäkologie

DOI 10.1055/s-2005-836904

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Abstract

The ENZIAN-Score is presented as a new instrument to classify the deep infiltrating endometriosis. Especially the retroperitoneal part of the severe endometriosis is focussed on. In analogy to an oncological staging four different stages are pronounced. The localisation and the expansion of the endometriosis nodule was indicated to different subgroups. The still used rAFS-score is of no clinical evidence, as we pointed out in a retrospective study of our patients with severe intestinal endometriosis.

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Value of transvaginal ultrasound in assessing severity of pelvic endometriosis
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Self-citation
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Genetic burden associated with varying degrees of disease severity in endometriosis
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Lymphangiogenesis in deep infiltrating endometriosis
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“The disease was staged during surgery, according to the ENZIAN system (Tuttlies et al., 2005).”
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Self-citation
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Self-citation
MRI of endometriosis in correlation with the #Enzian classification: applicability and structured report
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Self-citation
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Nomogram predicting the likelihood of complications after surgery for deep endometriosis without bowel involvement
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“Moreover, few data are available to determine whether the Enzian and ASRM (American Society for Reproductive Medicine) classifications are useful to predict postoperative complications [16,17].”
Background
An endometriosis classification, designed to be validated
Koninckx, P. R., Ussia, A., Adamyan, L. V., & Wattiez, A. (2010) · Gynecological Surgery · doi:10.1007/s10397-010-0626-8 · Cited by 32
EQUSUM: Endometriosis QUality and grading instrument for SUrgical performance: proof of concept study for automatic digital registration and classification scoring for r-ASRM, EFI and Enzian
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Self-citation
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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., et al. (2021) · Facts Views and Vision in ObGyn · doi:10.52054/fvvo.13.3.025 · Cited by 34
Follow-up of dysfunctional bladder and rectum after surgery of a deep infiltrating rectovaginal endometriosis
Kavallaris, A., Mebes, I., Evagyelinos, D., Dafopoulos, A., & Beyer, D. A. (2011) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-010-1833-2 · Cited by 28
Altered expression of progesterone receptor isoforms A and B in human eutopic endometrium in endometriosis patients
Wölfler, M. M., Küppers, M., Rath, W. H., Buck, V. U., Meinhold-Heerlein, I. M., & Classen-Linke, I. (2016) · Annals of Anatomy - Anatomischer Anzeiger · doi:10.1016/j.aanat.2016.03.004 · Cited by 30
Learning curves for laparoscopic hysterectomy after implementation of minimally invasive surgery
Mavrova, R., Radosa, J. C., Wagenpfeil, G., et al. (2016) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2016.01.017 · Cited by 28
Magnetic resonance imaging versus transvaginal ultrasound for complete survey of the pelvic compartments among patients with deep infiltrating endometriosis
Hernández, A., Spagnolo, E., Hidalgo, P., López, A. C. A., Zapardiel, I., & Roberto Rodríguez, G. (2019) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.12894 · Cited by 27
Diagnosis and treatment of rectovaginal endometriosis: an overview
KRUSE, C., SEYER‐HANSEN, M., & FORMAN, A. (2012) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/j.1600-0412.2012.01367.x · Cited by 26
Transvaginal Ultrasound in the Diagnosis and Assessment of Endometriosis—An Overview: How, Why, and When
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Interdisciplinary S2k Guidelines for the Diagnosis and Treatment of Endometriosis
Ulrich, U. A., Buchweitz, O., Greb, R. R., Keckstein, J., von Leffern, I., Oppelt, P., Renner, S. P., Sillem, M., Stummvoll, W., & Schweppe, K.-W. (2013) · Geburtshilfe und Frauenheilkunde · doi:10.1055/s-0033-1350810 · Cited by 26
Self-citation
Real world perspectives on endometriosis disease phenotyping through surgery, omics, health data, and artificial intelligence
Nezhat, C. R., Oskotsky, T. T., Robinson, J. F., Fisher, S. J., Tsuei, A., Liu, B., Irwin, J. C., Gaudilliere, B., Sirota, M., Stevenson, D. K., et al. (2025) · npj Women s Health · doi:10.1038/s44294-024-00052-w · Cited by 25
Structured manual for MRI assessment of deep infiltrating endometriosis using the ENZIAN classification
Burla, L., Scheiner, D., Hötker, A. M., Meier, A., Fink, D. A., Boss, A., & Imesch, P. (2020) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-020-05892-w · Cited by 24
Elevated immunoreactivity of RANTES and CCR1 correlate with the severity of stages and dysmenorrhea in women with deep infiltrating endometriosis.
Yang, Y., Zhang, X.-M., Zhou, C.-Y., Huang, X.-F., Lin, J., & Xu, H. (2013) · Acta Histochemica · doi:10.1016/j.acthis.2012.10.006 · Cited by 23
“At present, the ENZIAN classification has been introduced to rovide a better means of classifying DIE and an aid to describing IE (Tuttlies et al., 2005; Haas et al., 2011).”
Method
Transvaginal sonography accurately measures lesion‐to‐anal‐verge distance in women with deep endometriosis of the rectosigmoid
Aas‐Eng, M. K., Dauser, B., Lieng, M., Diep, L. M., Leonardi, M., Condous, G. S., & Hudelist, G. (2020) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.21995 · Cited by 23
Bowel Endometriosis Syndrome: a new scoring system for pelvic organ dysfunction and quality of life
Riiskjær, M., Egekvist, A. G., Hartwell, D., Forman, A., Seyer‐Hansen, M., & Kesmodel, U. S. (2017) · Human Reproduction · doi:10.1093/humrep/dex248 · Cited by 23
“The ENZIAN score (Tuttlies et al., 2005) aims to take the presence of deep infiltrating endometriosis into account and has been shown to display superior correlation with clinical symptoms compared with the ASRM score (Haas et al., 2013a,b), but it has not gained wider acceptance outside German…”
Result
QS ENDO Real – A Study by the German Endometriosis Research Foundation (SEF) on the Reality of Care for Patients with Endometriosis in Germany, Austria and Switzerland
Zeppernick, F. A., Zeppernick, M. M., Janschek, E., Wölfler, M. M., Bornemann, S., Holtmann, L., Oehmke, F., Brandes, I., Scheible, C. M., Salehin, D., et al. (2020) · Geburtshilfe und Frauenheilkunde · doi:10.1055/a-1068-9260 · Cited by 23
Self-citation
Structured report for dynamic ultrasonography in patients with suspected or known endometriosis: Recommendations of the International Society for Gynecologic Endoscopy (ISGE)
Djokovic, D., Pinto, P., van Herendael, B. J., Laganà, A. S., Thomas, V., & Keckstein, J. (2021) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2021.06.035 · Cited by 22
Self-citation
Accuracy and clinical value of an adhesion scoring system: A preoperative diagnostic method using transvaginal ultrasonography for endometriotic adhesion
Ichikawa, M., Akira, S., Kaseki, H., Watanabe, K., Ono, S., & Takeshita, T. (2020) · Journal of obstetrics and gynaecology research · doi:10.1111/jog.14191 · Cited by 22
The Levels of Ghrelin, Glucagon, Visfatin and Glp-1 Are Decreased in the Peritoneal Fluid of Women with Endometriosis along with the Increased Expression of the CD10 Protease by the Macrophages
Krasnyi, A., Sadekova, A., Smolnova, T., Chursin, V., Buralkina, N., Chuprynin, V., Yarotskaya, E., Pavlovich, S., & Sukhikh, G. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms231810361 · Cited by 20
Surgical outcome of deep infiltrating colorectal endometriosis in a multidisciplinary setting
Bachmann, R., Bachmann, C., Lange, J., Krämer, B., Brucker, S. Y., Wallwiener, D. R., Königsrainer, A., & Zdichavsky, M. (2014) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-014-3257-x · Cited by 21
Bowel anastomosis leakage following endometriosis surgery: an evidence based analysis of risk factors and prevention techniques.
Smith, A. V., Šumak, R., Cabrera, R., Kondo, W., & Ferreira, H. (2020) · PubMed · Cited by 22
Parametrial endometriosis: A predictive and prognostic factor for voiding dysfunction and complications
Benoit, L., Dabi, Y., Bazot, M., Thomassin‐Naggara, I., Ferrier, C., Puchar, A., Owen, C., Touboul, C., Daraï, É., & Bendifallah, S. (2022) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2022.07.035 · Cited by 21
Clinical characteristics and location of lesions in patients with deep infiltrating endometriosis using the revised Enzian classification
Morgan‐Ortiz, F., la Torre, M. A. L.-D., López-Zepeda, M. A., Morgan-Ruiz, F. V., Ortíz-Bojórquez, J. C., & Bolívar-Rodríguez, M. A. (2019) · Journal of the Turkish-German Gynecological Association · doi:10.4274/jtgga.galenos.2018.2018.0120 · Cited by 20
Non-invasive imaging techniques for diagnosis of pelvic deep endometriosis and endometriosis classification systems: an International Consensus Statement,
Condous, G. S., Gerges, B., Thomassin‐Naggara, I., Becker, C. M., Tomassetti, C., Krentel, H., van Herendael, B. J., Malzoni, M., Abrão, M. S., Sarıdoğan, E., et al. (2024) · Human Reproduction Open · doi:10.1093/hropen/hoae029 · Cited by 18
Self-citation
Recommendations for the surgical treatment of endometriosis Part 2: deep endometriosis †‡¶.
(2020) · PubMed Central · Cited by 18
Pre-operative mapping and structured reporting of pelvic endometriotic lesions on dynamic ultrasound and its correlation on laparoscopy using the #ENZIAN classification
Bindra, V., Nori, M., Mohanty, G. S., et al. (2022) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-022-06494-4 · Cited by 18
“1 3 Endometetrioseforschung (SEF) in 2003 and 2005 [6, 7].”
ENDO_STAGE Magnetic Resonance Imaging: Classification to Screen Endometriosis
Bazot, M., Daraï, É., Benagiano, G., Reinhold, C., Favier, A., Roman, H., Donnez, J., & Bendifallah, S. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11092443 · Cited by 17
Transvaginal Sonographic Imaging and Associated Techniques for Diagnosis of Ovarian, Deep Endometriosis, and Adenomyosis: A Comprehensive Review
Aas‐Eng, M. K., Montanari, E., Lieng, M., Keckstein, J., & Hudelist, G. (2020) · Seminars in Reproductive Medicine · doi:10.1055/s-0040-1718740 · Cited by 18
Self-citation
Complications and Their Management in Endometriosis Surgery
Karaman, Y., & Uslu, H. (2015) · Women s Health · doi:10.2217/whe.15.55 · Cited by 20
Macrophages and small extracellular vesicle mediated-intracellular communication in the peritoneal microenvironment: Impact on endometriosis development
Wang, Y., Dragovic, R., Greaves, E., Becker, C. M., & Southcombe, J. H. (2023) · Frontiers in Reproductive Health · doi:10.3389/frph.2023.1130849 · Cited by 19
“Depending on the location, depth and size of lesions and adhesions, endometriosis can be divided into stages I-IV using the rASRM (revised American Society for Reproductive Medicine) classification system (4); deeply infiltrating endometriosis can be further classified following the ENZIAN criteria (5) and pregnancy o…”
Method
Application of the #Enzian classification for endometriosis on MRI: prospective evaluation of inter- and intraobserver agreement
Harth, S., Kaya, H. E., Zeppernick, F. A., Meinhold-Heerlein, I. M., Keckstein, J., Yildiz, S. M., Nurkan, E., Krombach, G. A., & Roller, F. C. (2023) · Frontiers in Medicine · doi:10.3389/fmed.2023.1303593 · Cited by 18
Self-citation
Possible Role of the Posterior Compartment Peritonectomy, as a Part of the Complex Surgery, Regarding Recurrence Rate, Improvement of Symptoms and Fertility Rate in Patients with Endometriosis, Long-Term Follow-Up
Abesadze, E., Sehouli, J., Mechsner, S., & Chiàntera, V. (2019) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2019.08.019 · Cited by 17
ACOG Clinical Practice Guideline No. 11: Diagnosis of Endometriosis
(2026) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000006181 · Cited by 28
Evolution of Bowel Complaints after Laparoscopic Endometriosis Surgery: A 1497 Women Comparative Study
Namazov, A., Kathurusinghe, S., Mehdi, E., Merlot, B., Prosszer, M., Tuech, J., Marpeau, L., & Roman, H. (2021) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2021.11.018 · Cited by 15
Bladder Endometriosis: Diagnostic, Therapy, and Outcome of a Single-Center Experience
Piriyev, E., Schiermeier, S., & Römer, T. (2025) · Diagnostics · doi:10.3390/diagnostics15040466 · Cited by 15
“For the classi ﬁ cation of the endometriosis the For the classification of the endometriosis, we used the ASRM and ENZIAN/#ENZIAN classifications [17,23,24].”
Laparoscopic natural orifice specimen extraction colectomy versus conventional laparoscopic colorectal resection in patients with rectal endometriosis: a randomized, controlled trial
Dobó, N., Márki, G., Hudelist, G., Csibi, N., Brubel, R., Ács, N., & Bokor, A. (2023) · International Journal of Surgery · doi:10.1097/js9.0000000000000728 · Cited by 14
Does the Use of the “Proseek® Multiplex Oncology I Panel” on Peritoneal Fluid Allow a Better Insight in the Pathophysiology of Endometriosis, and in Particular Deep-Infiltrating Endometriosis?
Perricos, A., Wenzl, R. J., Husslein, H., Eiwegger, T., Gstoettner, M., Weinhaeusel, A., Beikircher, G., & Kuessel, L. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9062009 · Cited by 14
“In cases of DIE, the ENZIAN score [29] was applied by the surgeon in order to classify the lesions.”
Method
Proposal for a new ICD-11 coding classification system for endometriosis
Whitaker, L. H. R., Byrne, D. L., Hummelshøj, L., et al. (2019) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2019.08.015 · Cited by 14
Lesion‐to‐anal‐verge distance in rectosigmoid endometriosis on transvaginal sonography vs magnetic resonance imaging: prospective study
Aas‐Eng, M. K., Young, V. S., Dormagen, J. B., Pripp, A. H., Hudelist, G., & Lieng, M. (2022) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.26083 · Cited by 14
Preoperative pain and recurrence risk in patients with peritoneal endometriosis
Renner, S. P., Rix, S., Boosz, A. S., Lermann, J. H., Strissel, P. L., Thiel, F. C., Oppelt, P., Beckmann, M. W., & Fasching, P. A. (2009) · Gynecological Endocrinology · doi:10.1080/09513590903159623 · Cited by 13
Value of sonography in assessing parametrial endometriotic involvement: Preliminary results
Bazot, M., Delaveau, M.-C., Daraï, É., & Bendifallah, S. (2021) · Journal of Endometriosis and Pelvic Pain Disorders · doi:10.1177/2284026520984364 · Cited by 13
Fertility outcome after laparoscopic treatment of advanced endometriosis in two groups of infertile patients with and without ovarian endometrioma
Shervin, A., Mohazzab, A., Aminlou, M., Kamali, K., Padmehr, R., Shadjoo, K., Jaberi-Pour, P., & Akbari, E. (2016) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2016.03.009 · Cited by 12
Role of preoperative ultrasound mapping in the surgical management of deep infiltrating endometriosis: a prospective observational study
El-Maadawy, S. M., Alaaeldin, N., & Nagy, C. (2021) · The Egyptian Journal of Radiology and Nuclear Medicine · doi:10.1186/s43055-021-00526-w · Cited by 12
Diagnostik und Therapie der Endometriose
Müller, F., Drienko, E., & Ulrich, U. A. (2012) · gynäkologie + geburtshilfe · doi:10.1007/s15013-012-0015-7 · Cited by 12
Self-citation
Classifications of endometriosis
Aylamazyan, E. K., Yarmolinskaya, M. I., Молотков, А. С., & Tsitskarava, D. Z. (2017) · Journal of obstetrics and women s diseases · doi:10.17816/jowd66277-92 · Cited by 12
Major and minor complications after resection without bowel resection for deeply infiltrating endometriosis
Lermann, J. H., Topal, N., Adler, W., Hildebrandt, T., Renner, S. P., Beckmann, M. W., & Burghaus, S. (2018) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-018-4875-5 · Cited by 12

Authors: Tuttlies, F., Keckstein, J., Ulrich, U., Possover, M., Schweppe, K., Wustlich, M., Buchweitz, O., Greb, R., Kandolf, O., Mangold, R., Masetti, W., Neis, K., Rauter, G., Reeka, N., Richter, O., Schindler, A., Sillem, M., Terruhn, V., & Tinneberg, H.
ORCID: Keckstein, J.
Possover, M.
Schweppe, K.
Sillem, M.
Venue: Zentralblatt für Gynäkologie
Publisher: Georg Thieme Verlag KG
Published: 2005-09-29
Volume: 127
Issue: 05
Pages: 275-281
ISSN: 0044-4197 (ISSN-L)
1438-9762
DOI: 10.1055/s-2005-836904
OpenAlex: W1232911261
Cited by: 233
References: 0
Citations by year: 2026: 7 · 2025: 19 · 2024: 17 · 2023: 22 · 2022: 25 · 2021: 19 · 2020: 17 · 2019: 15 · 2018: 11 · 2017: 9 · 2016: 11 · 2015: 8 · 2014: 8 · 2013: 6 · 2012: 11
FWCI: 3.51
Type: journal article
Language: de
Open access: closed
Locations: Zentralblatt für Gynäkologie (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
Health Sciences › Medicine › Obstetrics and Gynecology › Endometrial and Cervical Cancer Treatments
Health Sciences › Medicine › Infectious Diseases › Diagnosis and treatment of tuberculosis
Keywords: deep infiltrating endometriosis, retroperitoneal endometriosis, endometriosis staging, classification systems, intestinal endometriosis
MeSH terms: Endometriosis, Female, Humans, Neoplasm Staging, Endometrial Neoplasms

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ENZIAN-Score, eine Klassifikation der tief infiltrierenden Endometriose

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