Table 1.

Comparison of the RCTs, prospective and retrospective studies included in this literature review. Papers have been grouped by intervention/ comparator

Study	Type of study	Age of participants (mean ± SD)	Intervention (n) vs Comparator (n)	Outcome	Pain	Cost
Pipelle versus D&C +/− Hysterectomy
[23] Rauf et al. Pakistan 2014	RCT	46.3 ± 4.45	Pipelle (102) vs D&C (101)	Adequacy Pipelle 98% D&C 100%	Pipelle less painful	Pipelle cheaper
[46] Liu et al. China 2015	Prospective Sequential	43.6	Pipelle vs D&C (245)	Adequacy Pipelle 91.02% D&C 92.24%	Pipelle less painful	N/A
[47] Gungorduk et al. Turkey 2013	Prospective	Pipelle: 49.8 ± 6.1 D&C: 48.2 ± 6.5	Pipelle + hysterectomy (78) vs D&C + hysterectomy (189)	Adequacy Pipelle 95% D&C 96% Concordance Pipelle + hysterectomy 62% D&C + hysterectomy 67%	Pipelle less painful	Pipelle cheaper
[48] Kazandi et al. Turkey 2012	Prospective Sequential	48 ± 9.43	Pipelle + hysterectomy Vs D&C + hysterectomy (66)	Adequacy Pipelle 93% D&C 96% Concordance Pipelle and D&C 66% Pipelle & hysterectomy 64%	Pipelle less painful	Pipelle cheaper
[49] Demirkiran et al. Turkey 2012	Prospective	45.3	Pipelle + hysterectomy (212) vs D&C + hysterectomy (161)	Adequacy Pipelle 97% D&C98% Concordance Pipelle and D&C 84% Pipelle & hysterectomy 67% D&C and hysterectomy 80%	Pipelle less painful	Pipelle cheaper
[43] Sany et al. UK 2011	Retrospective	?	Pipelle + hysterectomy vs D&C + hysterectomy (total 191)	Concordance Both techniques 78%	N/A	N/A
[45] Daud et al. UK 2011	Retrospective	55.7 ± 11.4	Pipelle ± hysterectomy (75) vs D&C ± hysterectomy (220)	Concordance Pipelle + hysterectomy 76% D&C + hysterectomy 86%	N/A	N/A
[24] Fakhar et al. Pakistan 2008	Prospective Sequential	45.4 ± 7.2	Pipelle versus (D&C) (100)	Adequacy Pipelle 98% D&C 100% NPV for endometrial carcinoma Pipelle 100%	N/A (both techniques under GA)	Pipelle cheaper
[44] Huang et al. USA 2006	Retrospective + Letter	?	Pipelle + hysterectomy (253) vs D&C + hysterectomy (93)	Concordance Pipelle and hysterectomy 93.8% (low grade cancer) & 99.2% (high grade cancer) D&C and hysterectomy 97% (low grade cancer) & 100% (high grade cancer)	N/A	N/A
[37] Macones et al. 2006
[66] Machado et al. Spain 2002	Retrospective	Post-menopausal (68) Pre- or peri-menopausal (100)	Pipelle (168) vs D&C (92) ± Hysterectomy (76)	Accuracy Sensitivity 84.2% Specificity 99.1%	N/A	N/A
[51] Kavak et al. Turkey 1996	Prospective	50.8 ± 7.8	Pipelle ± TVS (78) vs D&C (78)	Concordance Sensitivity: 73% (increased to 90% with TVS) Specificity: 100%	N/A	N/A
[50] Ben-Baruch et al. Israel 1993	Prospective	Pre- and post-menopausal	Pipelle (172) vs D&C (97)	Adequacy Pipelle 90.6% D&C 68%	N/A	N/A
[68] Sanam et al. Iran 2015	Prospective	>  35	Pipelle (130) vs D&C (130)	Concordance Pipelle and D&C 94% Adequacy Pipelle 84.6% D&C 90%	N/A	Pipelle cheaper
[75] Gordon New Zealand 1999	Prospective	47.2 ± 1.8	Pipelle (100) vs D&C or hysterectomy (n =?)	Adequacy Pipelle 67%	N/A	N/A
[69] Goldchmit et al. Israel 1993	Prospective Sequential	48.1	Pipelle and TVS vs D&C (176)	Concordance Pipelle & D&C 90% (increased to 92% with TVS)	N/A	N/A
[52] Abdelazim et al. Turkey 2013	Prospective Sequential	44.5	Pipelle vs D&C (143)	Adequacy Pipelle 97.9% D&C 100% NPV for endometrial polyp Pipelle 89.6%	N/A	N/A
[72] Shams Pakistan 2012	Prospective Sequential	47.94	Pipelle vs D&C (50)	N/A	Pipelle less painful	Pipelle cheaper
[53] Rezk et al. Egypt 2016	Prospective	Pipelle: 47.2 ± 3.8 D&C: 46.9 ± 4.1	Pipelle (270) vs D&C (268)	Adequacy No difference (p˃0.05)	D&C less painful	N/A
Pipelle versus Vabra +/− Hysterectomy
[54] Eddowes et al. UK 1990	Prospective Sequential	41.6	Pipelle vs Vabra Aspirator (100)	Adequacy Pipelle 88% Vabra Aspirator 88%	Pipelle less painful	Pipelle cheaper
[55] Naim et al. Malaysia 2007	RCT	> 45	Pipelle (76) vs Vabra Aspirator (71)	Adequacy Pipelle 73.3% Vabra 52.4%	N/A	Pipellle cheaper
[28] Kaunitz et al. USA 1988	Prospective Sequential	46	Pipelle vs Vabra (56)	Adequacy Pipelle & Vabra 91% Concordance Pipelle & Vabra 89%	Pipelle less painful	Pipelle cheaper
[56] Rodriguez et al. USA 1993	RCT	?	Pipelle (12) vs Vabra (13) vs Hysterectomy (25)	Surface being sampled: Pipelle 4.2% Vabra 41.6%	N/A	N/A
Pipelle versus Tao Brush+/− Hysteroscopy
[30] Williams et al. UK 2008	RCT Sequential	Moderate risk: 45.2 (SE 0.26)	For moderate risk Pipelle (34) Tao Brush (29)	Adequacy Both techniques 84% No significant difference for premenopausal	Tao Brush less painful	N/A
[57] Critchley et al. UK 2004	RCT	Moderate risk: pre-menopausal ˃40 or < 40 with risk for endometrial cancer Low risk	Pipelle vs Tao Brush Moderate risk (Total 326) Low risk (Total 157) ± hysteroscopy ± TVS	Successful completion of investigation: Pipelle 85% Adequacy of sample with Pipelle: Moderate risk 79%	Tao Brush less painful than Pipelle	Minimal difference
[58] Yang et al. USA 2003	Prospective Sequential	24–86	Pipelle (79) vs Tao Brush (79)	Factors affecting sensitivity: tumour size, type, location within the uterus, sampling mechanism and preparation method	N/A	N/A
[59] Del Priore et al. USA 2001	RCT Sequential	Pre-menopausal: 46 Post-menopausal: 61	Tao Brush vs Pipelle (50)	Sensitivity: Pipelle 86% Tao Brush 95.5% Specificity: Both 100%	N/A	Tao Brush cheaper than D&C
[60] Yang et al. USA 2000	Prospective Sequential	58	Tao Brush vs Tao Brush + Pipelle (25)	Adequacy Tao Brush 98% Pipelle 88%	Tao Brush less painful	Comparable
Pipelle versus Novak
[40] Henig et al. USA 1989	RCT	Pre-menopausal	Pipelle (50) Vs Novak (50)	Adequacy Pipelle 94% Novak 98%	Better tolerance with Pipelle	N/A
[26] Stovall et al. USA 1991	RCT	Pipelle: 40 Novak: 44	Pipelle (149) vs Novak (126)	Adequacy Pipelle 87.2% Novak 90.5%	Pipelle less painful	Novak might be cheaper
[61] Silver et al. USA 1991	RCT Sequential	28–76	1st Pipelle then Novak (26) vs 1st Novak then Pipelle (29)	Adequacy Similar	Pipelle less painful	N/A
Pipelle versus Hysterectomy
[67] Guido et al. USA 1995	Prospective Sequential	61	Pipelle vs Hysterectomy (71)	Adequacy Pipelle 97% Concordance Pipelle & hysterectomy 83%	N/A	N/A
[42] Ferry et al. UK 1993	Prospective Sequential	?	Pipelle vs Hysterectomy (37)	Concordance Pipelle & hysterectomy 67%	N/A	N/A
[41] G Zorlu et al. Turkey 1994	Prospective Sequential	51	Pipelle vs Hysterectomy (26)	Concordance Pipelle & hysterectomy 95%	Mild pain and discomfort with Pipelle	N/A
Pipelle versus Explora +/− Accurette
[62] Leclair et al. USA 2011	RCT	Pipelle: 45.2 ± 7.3 Explora: 46.1 ± 7.7	Pipelle (37) vs Explora (32)	Adequacy Pipelle 91% Explora 97%	No differences seen	N/A
[32] Lipscomb et al. USA 1994	RCT	N/A Pre- and post-menopausal	Pipelle (85) vs Accurette (81) vs Explora (82)	Adequacy Pipelle 85.2% Accurette 72.5% Explora 85.4%	No significant difference in pain score	N/A
Pipelle versus Infant Feeding Tube (IFT)
[63] Bhide et al. UK 2007	Prospective	?	Pipelle (29) vs IFT (31)	Adequacy Pipelle 73% IFT 71%	Less pain with IFT	N/A
Pipelle Mark 2 versus Pipelle Mark 2 + hysteroscopy
[71] Polena et al. France 2006	Prospective Sequential	50	Pipelle Mark 2 vs Pipelle Mark 2 ± hysteroscopy (97)	Adequacy of Pipelle Mark 2 88.7%	No difference with conventional Pipelle	Slightly more expensive than conventional Pipelle
Pipelle versus Tis-u-Trap
[27] Koonings et al. USA 1990	RCT	Pipelle: 42.9 Tis-u-trap: 42.3	Pipelle + hysterectomy (74) vs Tis-u-trap + hysterectomy (75)	Adequacy Pipelle 87.8% Tis-u-trap 84% Concordance Pipelle & hysterectomy 85% Tis-u-trap & hysterectomy 92%	N/A	Pipelle cheaper
Pipelle versus Endorette
[29] Moberger et al. Sweden 1998	RCT Sequential	57.5 ± 11.5	Pipelle vs Endorette (152)	Adequacy and concordance No difference	No significant difference	N/A
Pipelle versus Cytospat +/− Hysterectomy
[31] Antoni et al. Spain 1996	RCT	48.6 ± 9	Pipelle ± hysterectomy or D&C (191) vs Cytospat ± hysterectomy or D&C (174)	Adequacy Pipelle 75% Cytospat 76% Concordance Pipelle: Benign 84%, Hyperplasia 71%, Malignancy 60% Cytospat: Benign 82%, Hyperplasia 60%, Malignancy 60%	Better tolerance for Pipelle	Pipelle cheaper
Pipelle versus D&C +/− Hysteroscopy +/− TV US
[85] Tahir et al. UK 1999	RCT	35	Inpatient: Hysteroscopy & D&C (200) vs Outpatient: Pipelle +/− TV US +/− Hysteroscpy (200)	Adequacy No difference Concordance Inpatient: 100& Outpatient: 82&	More pain in outpatient	N/A
Others
[73] Trolice et al. USA 2000	RCT Anaesthesia for Pipelle	Lidocaine: 42.1 ± 11.9/ Saline: 44.9 ± 12.5	Lidocaine (19) vs Saline (22)	Significant reduction of pain with lidocaine	Less pain with intervention	N/A
[34] Cornier France 1984	Brief communication	Mostly pre-menopausal	Pipelle (250) No control	Useful for histologic dating of the endometrium	Little discomfort	Low cost
[74] Frishman USA 1990	Letter in response to study [27]	N/A	Pipelle versus Tis-u-Trap	N/A	N/A	Pipelle cheaper
[38] Mc Cluggage Northern Ireland 2006	Review	N/A	Pipelle versus other ES	Difficulties of processing outpatient ES samples	N/A	N/A
[79] Van Den Bosch Belgium 2005	Prospective sequential	Pre-menopausal: 41.6 ± 8.7 Post-menopausal: 59 ± 9.9	US before and after Pipelle (99)	Thickness of the endometrium ET on average 0.4 mm less after performing Pipelle	N/A	N/A
[76] Brandner et al. Germany 2000	Review	N/A	N/A	Progression of endometrial lesions (potential limitations for ES)	N/A	N/A
[80] Dijkhuizen et al. The Netherlands 2000	Meta-analysis	39 studies including 7914 patients	Different ES	Pipelle is superior to other ES for diagnosing cancer/ hyperplasia	N/A	N/A
[25] Cooper et al. USA 2000	Review	N/A	N/A	Directed biopsy with Hysteroscopy: most accurate ES (not for primary care)	N/A	N/A
[14] Farquhar et al. New Zealand 1996	Survey	68 replies from O&G consultants (48% of all contestants)	N/A	Management of menorrhagia in primary care	N/A	N/A
[78] Youssif et al. Australia 1995	Review	N/A	N/A	Effectiveness and safety of Pipelle	N/A	N/A
[77] Dantas et al. Brazil 1994	Letter	Nurses vs doctors performing Pipelle	N/A	Adequacy No difference	N/A	N/A
[82] Clark et al. UK 2002	Systematic review and meta-analysis	Mixed pre- (21%) and pos-tmenopausal (79%)	Pipelle vs other outpatient techniques	Likelihood ratio of endometrial cancer when Pipelle is: -ve: 0.1 +ve: 64.6	N/A	N/A
[86] Ahonkallio et al. Finland 2009	Prospective	Range 47–52 Post ablation	Pipelle (57)	Adequacy 29% failure If endometrium < 5 mm 5% failure if endometrium > 5 mm	N/A	N/A
[81] Du et al. China 2016	Review	N/A	N/A	Most appropriate ES devices for endometrial lesions	Little discomfort	N/A
[64] Masood et al. Pakistan 2015	Cross sectional	Pre- and post-menopausal 35–48	Pipelle (126) vs no comparator	Adequacy Pipelle 96.82%	N/A	Cost-effective
[39] Seamark UK 1998	Prospective	≥40 42–74 Primary care population	Pipelle (38) vs no comparator	Adequacy Pipelle 76%	N/A	N/A
[70]Seto UK 2016	Retrospective	Pre-menopausal 46.1 ± 4.6 Post-menopausal 57.2 ± 8.1	Pipelle against hysteroscopy	Positive predictive value for endometrial polyp Pipelle (pre-menopausal) 53.7%	N/A	N/A
[65] Piatek et al. Poland 2016	Retrospective	Pre- and post-menopausal	Pipelle (312) vs no comparator	Adequacy 83.01%	N/A	N/A

ES Endometrial sampling, AUB Abnormal uterine bleeding, RCT Randomized controlled trials, US Transvaginal ultrasound, N/A Non-applicable,? Unknown