• Raazia Rauf
  • Asma Shaheen
  • Shamsunisa Sadia
  • Faressa Waqar
  • Shamsa Zafar
  • Saadia Sultana
  • Shumaila Waseem


Background: Pipelle is a silastic curette which does not require a tenaculum or straightening of the cervical fundus axis because of its flexibility and does not require general anaesthesia. whereas Dilatation and curettage (D&C) requires hospitalization and general anaesthesia along with the problem of postoperative pain. The objective of the study was to assess the effectiveness of Pipelle sampling in terms of adequate specimen collection and patients’ knowledge and perception about Pipelle and compare it D&C. Methods: In this randomized control trial, 203 women presenting with abnormal uterine bleeding were enrolled. The patients were randomly assigned to one of the two procedures. In group A 102 patients were subjected to Pipelle endometrial sampling and in group B 101 patients were enrolled for D&C. Frequencies of adequacy of histopathology reports and cost effectiveness of both groups were compared. Patient’s knowledge, perception, pain and acceptability of the procedure of both groups were also assessed and compared. Results: The mean age of the patients was 46.3±4.45 years. Tissue obtained for histopathology was 100% adequate when the procedure was D&C while it was 98% in Pipelle group. In group-A 92% patients experienced no discomfort, with only 2% experiencing severe pain and 6% mild pain. On the other hand in group-B, 45% patients experienced moderate and 5% experienced severe pain up to 9 on visual analogue scale (VAS) postoperatively and requiring post-operative analgesia. The acceptability for the Pipelle suction curette was 98% and for the D&C group was 34%. Regarding previous knowledge of procedure none of patients (100%) knew about Pipelle procedure but 98% patients were aware of D&C procedure. Pipelle was eight times more cost effective as compared to D&C. Conclusions: The results of obtained by endometrial sample by Pipelle and D&C are compareable. Pipelle significantly produced less pain than D&C.Keywords: Pipelle, suction curette, dilatation and curettage, pre-menopause, visual analogue scale


Spence CP, Whitehead MI. Endometrial assessment revisited. Br J Obstet Gynaecol 1999;106:623–32.

Gorman TO, Hollingworth T. Postmenopausal bleeding. In: Dunlop W, Ledger WL, editors. Recent Advances in Obstetrics and Gynaecology. 24th ed. UK: Royal Society of Medicine Press Ltd; 2008.p. 245–58.

Behnamfar F, Khamehchian T, Mazoochi T, Fahiminejad T. Diagnostic value of endometrial sampling with Pipelle suction curettage for identifying endometrial lesions in patients with abnormal uterine bleeding. J Res Med Sci 2004;3:123–5

Berek JS, Hacker NF, editors. Practical Gynacologic Oncology. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2000.

Fakhar S, Saeed G, Khan AH, Alam AY. Validity of Pipelle endometrial sampling in patients with abnormal uterine bleeding. Ann Saudi Med 2008;28:188–91.

Seamark CJ. Endometrial sampling in general practice. Br J Gen Pract 1998;48:1597–8.

Check JH, Chase JS, Nowroozi K, Wu CH, Chern R. Clinical evaluation of Pipelle endometrial suction curette for timed endometrial biopsies. J of Reproductive Medicine 1989;34:218–20.

Rock JA, Howard W. Jones HW 3rd, editors. Te Linde’s Operative Gynaecology. 9th ed. Philadelphia, Pa : Lippincott Williams & Wilkins; 2003.

Guido RS, Stovall DW. Endometrial sampling procedure up to date (online serial). In: Wathan MA. Up to date; 2008.

Choudry A, Javaid M. Clinical usefulness of Pipelle endometrial sampling. Pak Armed Forces Med J 2005;55:122–5.

Bakour SH, Khan KS, Gupta JK. Transvaginal Ultrasonography and Endometrial histology in peri and post-menopausal women on hormonal replacement therapy (letter). Br J Obstet Gynaecol 2000;107:295.

Dijkhuizen FP, Mol BW, Brolmann HA, Heintz AP. The Accuracy of Endometrial Sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta-analysis. Cancer 2000;89:1765–72.

Clark TJ, Mann CH, Shah N, Khan KS, Song F, Gupta JK. Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial carcinoma: a systemic quantitative review. Br J Obstet Gynecol 2002;109:313–21.

Machado F, Moreno J, Carazo M, Leon J, Fiol G, Serna R. Accuracy of Endometrial biopsy with the Cornier Pipelle for diagnosis of endometrial carcinoma and Atypical hyperplasia. Eur J Gynaecol Oncol 2003;24:279–81.

Clark TJ, Mann CH, Shah N, Khan KS, Song F, Gupta JK. Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial hyperplasia. Acta Obstet Gynecol Scand 2001;80:784–93.

Schneider J, Centena MM, Austin J. Use of Cornier pipelle as the only mean of pre surgical histologic diagnosis in endometrial carcinoma: agreement between initial and final histology. Eur J Gynaecol Oncol 2000;21:74–5.

Critchley HO, Warner P, Lee AJ, Brechin S, Guise J, Graham B. Evaluation of Abnormal uterine bleeding .comparison of three outpatient procedure with in cohorts defined by age and menopausal status. Health Technol Assess 2004;8(34):iii–iv, 1–139