EMMY at 10 Years: Two-Thirds Avoid Hysterectomy

Show notes

This fundamentals episode breaks down the 10-year results of the EMMY trial, the Dutch randomized comparison of uterine artery embolization (UAE) versus hysterectomy for symptomatic uterine fibroids, and the longest randomized follow-up of the two treatments reported so far. Following, there is an expert commentary by Dr. James Spies, Chair of Radiology at Georgetown University.

• The Premise: Since 1995, UAE has been described as an alternative to hysterectomy for symptomatic fibroids. EMMY asked whether the benefit holds up a decade later.
• The Trial: 28 Dutch hospitals randomized 177 premenopausal women with heavy menstrual bleeding from fibroids, all eligible for hysterectomy, 1:1 between 2002 and 2004. 81 underwent UAE and 75 hysterectomy, with a mean follow-up of 133 months.
• Efficacy: By 10 years, 28 of 81 UAE patients (35%) had a secondary hysterectomy, 5 of them between years 5 and 10. About two-thirds avoided hysterectomy, and the success rate was 69% after an initially successful UAE.
• Quality of Life: Generic quality of life improved after treatment in both groups and stayed stable at 10 years with no difference between arms. Urinary and bowel function scores fell in both groups, probably from aging, without significant differences between arms.
• Satisfaction: 78% of UAE patients and 87% of hysterectomy patients were (very) satisfied (P = .77), and 81% versus 84% would recommend their treatment to a friend.
• The Catch: Secondary hysterectomies kept accruing beyond 5 years, and UAE failure was associated with BMI above 25 (OR 3.29) and smoking (OR 3.24), so long-term follow-up matters when counseling patients.
• Expert Take: Dr. Spies calls EMMY one of the landmark studies in uterine embolization, but notes issues that may skew long-term results: 17% of patients did not have both uterine arteries embolized and were counted as procedural failures, partly because many sites were performing their first embolizations, and patient management was handled entirely by gynecologists. As the longest follow-up of a randomized trial, and unlikely to be matched in quality, he says it remains the gold standard for long-term outcomes.

Tune in to learn why UAE is a well-documented, less invasive alternative to hysterectomy that eligible patients should be counseled on.

This podcast is generated using an AI model that has been trained in the context of endovascular surgery and interventional radiology in addition context of the article cited below. The content was reviewed and edited by multiple healthcare professionals in the field.

de Bruijn AM, Ankum WM, Reekers JA, et al. Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial. Am J Obstet Gynecol. 2016. https://doi.org/10.1016/j.ajog.2016.06.051