Endosampler versus Pipelle

Endometrial sampling is a crucial procedure in gynaecology, where a small tissue sample is taken from the lining of the uterus for examination. This provides a valuable specimen for the evaluation of abnormal uterine bleeding, postmenopausal bleeding and suspected endometrial pathology. Most Gynaecologists are currently using a standard pipelle. However, another device gaining attention is the Endosampler from Hallmark Surgical. To explain the differences between the devices, we have written an article covering the pros and cons of each device.

Endosampler:

The Endosampler is a unique sterile disposable curette for sampling the endometrium.

Pros of the Endosampler:

• Stiffer and Curved Tip: The Endosampler has a stiffer tip, making it easier to insert into a stenosed cervix, which creates resistance at the internal os. The tip curvature suits the natural curve of the cervix, allowing more efficient access and sampling from all the full endometrium. It is also found that without using local anaesthetic, the Endosampler is still very well tolerated by women with this curved tip as it reduces the manipulation of the device required by the consultant.

• Fewer Hysteroscopies Needed: Due to the reasons above, the Endosampler means fewer women needing hysteroscopies. Higher sample success rates with Endososampler result in a shorter procedure time, less discomfort for the patient, and ultimately fewer patients undergoing hysteroscopies. This is great for women, Gynaecologists and healthcare organisations as routine hysteroscopies just for endometrial sampling are decreased, bringing down costs and patient impact with it.

Cons of the Endosampler:

• Cost: The Endosampler is typically more expensive than a traditional pipelle. The Endosampler ranges from $21.00-$28.00 per unit. Whereas a pipelle ranges from $9.00-$11.00 per unit. This can often be a problem where the hospital or clinic wants to provide more cost-effective devices without increasing inventory expenses. However, the Endosampler reduces the amount of hysteroscopies needed. This can ultimately mean cost savings in the long run because these large procedures cost more and take a lot more time.

• Device isn’t as common: The Endosampler is a less established device in the New Zealand market. It is a newer device, and fewer long-term clinical studies have been done. A traditional pipelle has been in the market for many years and has ongoing data collection. Many are aware of the trusted pipelle, which makes switching to an Endosampler more hesitant.

• Reduced Flexibility: Some surgeons may not like the less flexible rigid design of the Endosampler. This may require a change in technique, which is different to your traditional sampling methods. Therefore, support and training are needed so staff can use the device correctly.

Pipelle:

Hallmark Surgical also offers a standard pipelle, which is used to sample the endometrium by getting a small tissue sample from the uterus lining.

Pros of the Pipelle:

• Cost: The standard pipelle costs less per unit than the Endosampler. As mentioned the pipelle ranges from $9.00-$11.00 per unit. This is around two times cheaper than the Endosampler device, which is more favourable for many hospitals and clinics. However, it may result in a less successful sampling rate, leading to a higher cost as a patient requires a hysteroscopy.

• Flexibility: The pipelle has higher flexibility compared to the Endosampler. Some consultants find this can make it easier for the to navigate the curves of the cervix and can minimise cramping therefore more comfortable for the patient. The softer, more flexible cannula also provides a lower risk for the endometrium to be perforated.

• Well-known device: The pipelle is a well-known device loved by many across New Zealand. It is a well-established device that has been around for a long time and is a trusted product. It is widely available globally from multiple manufacturers, requiring minimal training to use the device.

Cons of the Pipelle:

• Sampling a few times: The pipelle often requires more than one sample to be sufficient. It collects less endometrial tissue than the Endosampler. In some cases, an extra person is needed to hold a bottle to put the sample into. A standard pipelle has also been known to have false negative results, especially in postmenopausal women with a thin endometrium.

• Higher chance of hysteroscopy: As mentioned, when a surgeon doesn’t get a sufficient sample, which can be common with a pipelle, a routine hysteroscopy is required. If a scan was done on a patient where it was borderline thick endometrium and the pipelle was insufficent it is therefore warranted to investigate with a hysteroscopy. Whereas getting a better sample, which the Endosampler does, many of these patients may not have required a hysteroscopy.

• Patient discomfort: The pipelle can often cause discomfort to the patient as multiple samples may be taken. The surgeon must go in more than once; therefore, it takes longer and is more uncomfortable. With a thin endometrium, it is harder to get a sufficient sample; these are likely to be the postmenopausal women who find the exam uncomfortable to start with. To have to do a sample a few times with a pipelle to get enough tissue for sampling can be very uncomfortable. With the Endosampler, you can get a sufficient sample the first time; therefore, it is more tolerated by women.

The Endosampler and pipelle are valuable devices for sampling the endometrium, but they have advantages and disadvantages. The ideal choice can often come down to cost, surgeon preference and what works best for sampling. However, many have come on board with the Endosampler due to its greater advantages. It gives you a better sample the first time round. The tip is stiffer and curved, making it easier to insert, and ultimately, fewer hysteroscopies are needed. It is more expensive than a tradtional pipelle, however many Gynaecologists feel these benefits outweigh the price increase.

To hear Dr Aggie Them thoughts since changing from a pipelle to the Endosampler, click the link below: