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Enzian classification: does it correlate with clinical symptoms and the rASRM score?


  • The authors hereby state that there were no conflicts of interest.


Dietmar Haas, Allgemeines Krankenhaus Linz, Abteilung für Gynäkologie und Geburtshilfe, Krankenhausstrasse 9, A-4021 Linz, Austria. E-mail:



To assess the extent to which the Enzian classification correlates with the revised American Society for Reproductive Medicine (rASRM) score and clinical symptoms in women with deeply infiltrating endometriosis.


Retrospective cohort study (Canadian Task Force classification II-2).


Endometriosis competence center specializing in minimally invasive surgery.


Between 1 January 2009 and 31 December 2011, a total of 194 women underwent surgery due to deeply infiltrating endometriosis. After histological confirmation, they were classified using the rASRM and Enzian systems. Clinical symptoms were recorded preoperatively.


Operative laparoscopy to treat endometriosis.

Main outcome measures and Results

A clear correlation was seen between grades of severity in the rASRM score and the Enzian classification (p < 0.001). In addition, the rASRM severity grade and clinical symptoms correlated with the locations in the Enzian classification in relation to deeply infiltrating endometriosis. Pain and dysmenorrhea correlated strongly (p = 0.002, p < 0.001) with the severity grade in the Enzian classification.


Deeply infiltrating endometriosis is well characterized using the Enzian classification as a supplement to the rASRM score. There is also a clear correlation between the rASRM and Enzian classifications, because of the way in which the disease crosses morphological boundaries. The locations in the Enzian classification correlate partially with clinical symptoms, and the classification's severity grades correlate substantially with pain and dysmenorrhea. In view of these clinical results, use of the Enzian classification can be recommended as a supplement to the rASRM score for detailed description of endometriosis.