The rASRM score and the Enzian classification for endometriosis: their strengths and weaknesses
Open accessAbstract
The revised American Society for Reproductive Medicine (rASRM) score is currently the best‐known classification of endometriosis and is the one most widely used throughout the world. It is relatively easy to use, but it does not take into account the involvement of retroperitoneal structures with deeply infiltrating endometriosis. For this reason, the Enzian classification was developed as a supplement to the rASRM score, in order to provide a morphologically descriptive classification of deeply infiltrating endometriosis. The Enzian classification currently has a poor level of international acceptance and is mainly used in the German‐speaking countries. It was revised in 2011 and is now also easier to use. This article describes the strengths and weaknesses of the rASRM score and the Enzian classification and their common potential for classifying endometriosis.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The stage of endometriosis was classified in accordance with the revised American Society for Reproductive Medicine classification.
“The stage of endometriosis was classified in accordance with revised American Society for Reproductive Medicine classification.18”
From Robotic-assisted laparoscopy is a feasible method for resection of deep infiltrating endometriosis, especially in the rectosigmoid area (2021) · cites this paper as [18]
Cites
Revised American Society for Reproductive Medicine classification of endometriosis: 1996
American Society for Reproductive Medicine (1997) · Fertility and Sterility · doi:10.1016/s0015-0282(97)81391-x · Cited by 3,018 · see citing works
Revised American Fertility Society Classification of Endometriosis: 1985
(1985) · Fertility and Sterility · doi:10.1016/s0015-0282(16)48430-x · Cited by 1,803 · see citing works
PERFORATING HEMORRHAGIC (CHOCOLATE) CYSTS OF THE OVARY
SAMPSON, J. A. (1921) · Archives of Surgery · doi:10.1001/archsurg.1921.01110080003001 · Cited by 492 · see citing works
Endometriosis fertility index: the new, validated endometriosis staging system
Adamson, G. D., & Pasta, D. J. (2010) · Fertility and Sterility · doi:10.1016/j.fertnstert.2009.09.035 · Cited by 483 · see citing works
Endometriosis and pelvic pain: relation to disease stage and localization
Vercellini, P., Trespidi, L., De Giorgi, O., Cortesi, I., Parazzini, F., & Crosignani, P. G. (1996) · Fertility and Sterility · doi:10.1016/s0015-0282(16)58089-3 · Cited by 457 · see citing works
Bazot, M., Lafont, C., Rouzier, R., Roseau, G., Thomassin-Naggara, I., & Daraï, E. (2009) · Fertility and Sterility · doi:10.1016/j.fertnstert.2008.09.005 · Cited by 434 · see citing works
Classification of Endometriosis
The American Fertility Society (1979) · Fertility and Sterility · doi:10.1016/s0015-0282(16)44409-2 · Cited by 305 · see citing works
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., et al. (2005) · Zentralblatt für Gynäkologie · doi:10.1055/s-2005-836904 · Cited by 233 · see citing works
A proposed classification of pelvic endometriosis.
Acosta, A. A., Buttram, V. C., Pk, B., Malinak, L. R., Rr, F., & Jd, V. (1973) · PubMed · Cited by 232 · see citing works
Hudelist, G., Ballard, K., English, J., Wright, J., Banerjee, S., Mastoroudes, H., Thomas, A. E., Singer, C., & Keckstein, J. (2011) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.8935 · Cited by 203 · see citing works
Guzick, D. S., Silliman, N. P., Adamson, G. D., Buttram, V. C., Canis, M. J., Malinak, L. R., & Schenken, R. S. (1997) · Fertility and Sterility · doi:10.1016/s0015-0282(97)81392-1 · Cited by 187 · see citing works
Endometriosis classification: an update
Adamson, G. D. (2011) · Current Opinion in Obstetrics & Gynecology · doi:10.1097/gco.0b013e328348a3ba · Cited by 119 · see citing works
Haas, D., Chvátal, R., Habelsberger, A., et al. (2011) · Fertility and Sterility · doi:10.1016/j.fertnstert.2011.01.135 · Cited by 92 · see citing works
Self-citationThe reproducibility of the revised American Fertility Society classification of endometriosis
Hornstein, M. D., Gleason, R. E., Orav, E. J., Haas, S. T., Friedman, A. J., Rein, M. S., Hill, J. A., & Barbieri, R. L. (1993) · Fertility and Sterility · doi:10.1016/s0015-0282(16)55921-4 · Cited by 92 · see citing works
Reliability of the visual diagnosis of ovarian endometriosis
Vercellini, P., Vendola, N., Bocciolone, L., Rognoni, M. T., Carinelli, S. G., & Candiani, G. B. (1991) · Fertility and Sterility · doi:10.1016/s0015-0282(16)54744-x · Cited by 68 · see citing works
Haas, D., Chvátal, R., Habelsberger, A., et al. (2012) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2012.10.012 · Cited by 40 · see citing works
Self-citationEndometriosis - A Disease that has no Lobby
Schweppe, K.-W. (2003) · Zentralblatt für Gynäkologie · doi:10.1055/s-2003-42275 · Cited by 34 · see citing works
Current guidelines for treatment of endometriosis without laparoscopy.
Candiani, M. (2005) · PubMed · Cited by 12 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Pathophysiology, diagnosis, and management of endometriosis
Horne, A. W., & Missmer, S. A. (2022) · BMJ · doi:10.1136/bmj-2022-070750 · Cited by 661 · see citing works
Anxiety and depression in patients with endometriosis: impact and management challenges
Laganà, A. S., La Rosa, V. L., Rapisarda, A. M. C., Valenti, G., Sapia, F., Chiofalo, B., Rossetti, D., Ban Frangež, H., Vrtačnik Bokal, E., & Giovanni Vitale, S. (2017) · International Journal of Women's Health · doi:10.2147/ijwh.s119729 · Cited by 405 · see citing works
Grundström, H., Gerdle, B., Alehagen, S., Berterö, C., Arendt‐Nielsen, L., & Kjølhede, P. (2019) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/aogs.13508 · Cited by 91 · see citing works
Hudelist, G., Aas‐Eng, M. K., Birsan, T., Berger, F., Sevelda, U., Kirchner, L., Salama, M., & Dauser, B. (2018) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/aogs.13436 · Cited by 75 · see citing works
New biomarkers in endometriosis
(2019) · Advances in clinical chemistry · doi:10.1016/bs.acc.2018.12.002 · Cited by 72 · see citing works
The known, the unknown and the future of the pathophysiology of endometriosis
Ochoa Bernal, M. A., & Fazleabas, A. T. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25115815 · Cited by 59 · see citing works
“Therefore, in order to include that component, the ENZIAN classification was developed [163].”
MethodPraetorius, T. H., Leonova, A., Lac, V., Senz, J., Tessier-Cloutier, B., Nazeran, T. M., Köbel, M., Grube, M., Kraemer, B., Yong, P. J., et al. (2022) · Fertility and Sterility · doi:10.1016/j.fertnstert.2022.05.030 · Cited by 43 · see citing works
Poupon, C., Owen, C., Arfi, A., Cohen, J., Bendifallah, S., & Daraï, E. (2019) · European Journal of Obstetrics & Gynecology and Reproductive Biology: X · doi:10.1016/j.eurox.2019.100028 · Cited by 31 · see citing works
Netzl, J., Gusy, B., Voigt, B., Sehouli, J., & Mechsner, S. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11133714 · Cited by 24 · see citing works
Effects of localization of uterine adenomyosis on clinical features and pregnancy outcome
Shi, J., Wu, Y., Li, X., Gu, Z., Zhang, C., Yan, H., Dai, Y., & Leng, J. (2023) · Scientific Reports · doi:10.1038/s41598-023-40816-z · Cited by 20 · see citing works
Hiltunen, J., Eloranta, M.-L., Lindgren, A., Keski-Nisula, L., Anttila, M., & Sallinen, H. (2021) · Journal of International Medical Research · doi:10.1177/03000605211032788 · Cited by 15 · see citing works
“The stage of endometriosis was classified in accordance with revised American Society for Reproductive Medicine classification.(18) Briefly, the stage of endometriosis is divided into the four stages of I (minimal), II (mild), III (moderate) and IV (severe).”
MethodTiringer, D., Pedrini, A. S., Gstoettner, M., Husslein, H., Kuessel, L., Perricos, A., & Wenzl, R. (2022) · BMC Women's Health · doi:10.1186/s12905-022-02111-3 · Cited by 15 · see citing works
Long‐term surgical outcomes of nerve‐sparing discoid and segmental resection for deep endometriosis
Darici, E., Denkmayr, D., Pashkunova, D., Dauser, B., Birsan, T., & Hudelist, G. (2022) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/aogs.14411 · Cited by 14 · see citing works
- Authors
- HAAS, D., SHEBL, O., SHAMIYEH, A., & OPPELT, P.
- Affiliations
- Universitätsklinikum Erlangen (DE)
- Women's General Hospital (AT)
- Gespag (AT)
- Corresponding author
- HAAS, DIETMAR
- Venue
- Acta Obstetricia et Gynecologica Scandinavica
- Publisher
- Wiley
- Published
- 2012-11-05
- Volume
- 92
- Issue
- 1
- Pages
- 3-7
- ISSN
- 0001-6349 (ISSN-L)
- 1600-0412
- OpenAlex
- W1546737420
- Cited by
- 204
- References
- 18
- Citations by year
- 2026: 15 · 2025: 18 · 2024: 28 · 2023: 17 · 2022: 24 · 2021: 25 · 2020: 24 · 2019: 10 · 2018: 8 · 2017: 11 · 2016: 8 · 2015: 8 · 2014: 3 · 2013: 5
- FWCI
- 5.96
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Acta Obstetricia Et Gynecologica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
- Keywords
- endometriosis, Enzian classification, endometriosis classification, deep infiltrating endometriosis, retroperitoneal endometriosis, morphological classification, diagnostic scoring system
- MeSH terms
- Diagnostic Techniques, Obstetrical and Gynecological, Endometriosis, Female, Humans, Severity of Illness Index, Societies, Medical, United States
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
