Flexible cystoscopy and vaginoscopy: A case series on assisted endometrial biopsy to overcome anatomic barriers

This case series explores an innovative technique for endometrial sampling in patients facing anatomical challenges, such as cervical stenosis and morbid obesity, which often hinder traditional methods. Endometrial sampling is essential in diagnosing abnormal uterine bleeding, yet limitations such as patient tolerance, inadequate tissue procurement, and anatomical barriers can complicate the procedure. Existing solutions, including chemically induced cervical dilation and endocervical resection, pose additional risks. The report highlights two clinical cases of successful endometrial biopsies achieved using a flexible cystoscope. The first patient, a morbidly obese 35-year-old with severe cervical stenosis, underwent an examination under anesthesia and attempted hysteroscopic dilation and curettage, ultimately achieving success on the second attempt with the cystoscope. The second case involved a 77-year-old, never sexually active patient who also faced cervical stenosis, but was successfully biopsied with the flexible cystoscope after initial challenges. This technique, which enhances access to the endometrial cavity without introducing new risks, represents a promising alternative for patients with complex anatomical barriers, contributing valuable insights to the existing literature on endometrial sampling procedures. Learning point: the use of a flexible cystoscope can successfully facilitate endometrial sampling in patients with anatomical barriers such as cervical stenosis and morbid obesity, offering a safer alternative to traditional methods.