Conservative treatment of rectosigmoid endometriosis: A prospective study

Egekvist, Anne Gisselmann; Marinovskij, Edvard; Forman, Axel; Kesmodel, Ulrik Schiøler; Graumann, Ole; Seyer‐Hansen, Mikkel

doi:10.1111/aogs.13619

Cited by 13 publications

(10 citation statements)

References 29 publications

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“…Barra et al [33] [32] reported persistence of pain symptoms in the vast majority of women in whom the nodule regressed or remained stable. On the other hand, Egekvist et al [29] observed that progression of nodule volume dimensions occurred without worsening of symptoms or healthrelated quality of life. Barra et al [33] also confirmed that the increase in endometriotic nodule volume during dienogest therapy was not always associated with worsening of clinical symptoms.…”

Section: Rationale For Hormonal Treatment Of Bowel Endometriosismentioning

confidence: 99%

“…Egekvist et al [29] followed 80 women with rectosigmoid or rectovaginal nodules treated for at least 12 months with a levonorgestrel-releasing intrauterine device (LNG-IUD; n=49), an oral contraceptive (n=12), a progestogen (n=9), or a combination of therapies (n=10). The nodule length and width increased in nine and six patients, respectively.…”

Section: Rationale For Hormonal Treatment Of Bowel Endometriosismentioning

confidence: 99%

“…a Egekvist et al [29] was not included because the exact number of patients who used different medical treatments (oral oestrogen-progestogens, progestogens, or LNG-IUD), the adverse effects associated with their use, and the precise pain symptoms or gastrointestinal symptoms variation could not be extracted from the published report.…”

Section: Sourcementioning

confidence: 99%

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Advances in the medical management of bowel endometriosis

Vercellini

Sergenti

Buggio

et al. 2021

Best Practice & Research Clinical Obstetrics & Gynaecol

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Endometriosis infiltrating the bowel can be treated medically in accurately selected women not seeking conception and without overt obstructive symptomatology. When the rectosigmoid junction is involved, the probabilities of intestinal symptoms relief, undergoing surgery after treatment failure, and developing bowel obstruction during hormonal treatment are around 70%, 10%, and 1-2%, respectively. When the lesion infiltrates exclusively the mid-rectum, thus in cases of true rectovaginal endometriosis, the probabilities of intestinal symptoms relief and undergoing surgery are about 80% and 3%, respectively. Endometriotic obstructions of the rectal ampulla have not been reported. A recto-sigmoidoscopy or colonoscopy should be performed systematically before starting medical therapies, also to rule out malignant tumours arising from the intestinal mucosa. Progestogens are safe, generally effective, well tolerated, inexpensive, and should be considered as first-line medications for bowel endometriosis. Independently of symptom relief, intestinal lesions should be checked periodically to exclude nodule progression during hormonal treatment.

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Section: Rationale For Hormonal Treatment Of Bowel Endometriosismentioning

confidence: 99%

Section: Rationale For Hormonal Treatment Of Bowel Endometriosismentioning

confidence: 99%

See 1 more Smart Citation

Advances in the medical management of bowel endometriosis

Vercellini

Sergenti

Buggio

et al. 2021

Best Practice & Research Clinical Obstetrics & Gynaecol

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“…Possible disease progression of rectosigmoid endometriosis should be monitored 91 ; however, further research is needed to evaluate whether TVS is useful in these cases. 92 If medical treatment fails, surgical therapy may be warranted. From a surgical point of view, it is essential to know the estimated distance from the bowel lesion to the anal verge for estimation of anastomotic height.…”

Section: Rectosigmoidmentioning

confidence: 99%

Transvaginal Sonographic Imaging and Associated Techniques for Diagnosis of Ovarian, Deep Endometriosis, and Adenomyosis: A Comprehensive Review

et al. 2020

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Imaging of endometriosis and in particular deep endometriosis (DE) is crucial in the clinical management of women facing this debilitating condition. Transvaginal sonography (TVS) is the first-line imaging method and magnetic resonance imaging (MRI) may provide supplemental information. However, the delay in diagnosis of up to 10 years and more is of concern. This problem might be overcome by simple steps using imaging with emphasis on TVS and referral to tertiary care. Finally, TVS is crucial in mapping extent and location of disease in planning surgical therapy and counseling women regarding various therapeutic options. This review presents the available data on imaging of endometriosis with a focus on TVS and MRI for DE, adenomyosis, and ovarian endometriomas including endometriomas in pregnancy as well as the use of “soft markers.” The review presents an approach that is in accordance with the International Deep Endometriosis Analysis (IDEA) group consensus statement.

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“…In cases in which medical treatment fails, surgical resection either by discoid resection (DR) or segmental resection (SR) is often the treatment of choice. Surgical treatment of DE affecting the rectosigmoid has been shown to decrease pain, and may be beneficial for fertility [3][4][5][6][7] . Transvaginal sonography (TVS) is a cost-effective, highly accurate and non-invasive tool that is regarded as the first line technique in assessing women with endometriosis, especially when DE is suspected [8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

Transvaginal sonography accurately measures lesion‐to‐anal‐verge distance in women with deep endometriosis of the rectosigmoid

Aas-Eng

Dauser

Lieng

et al. 2020

Ultrasound in Obstet & Gyne

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Objectives First, to investigate the accuracy of transvaginal sonography (TVS) for presurgical evaluation of the distance between the most caudal part of the endometriotic lesion and the anal verge (lesion‐to‐anal‐verge distance (LAVD)) in women with rectosigmoid deep endometriosis (DE), compared with intraoperative measurement (IOM). Second, to assess the agreement between anastomosis height and LAVD measured using TVS. Methods This was a prospective observational multicenter study of symptomatic women who were scheduled for surgical treatment of rectosigmoid DE, by either discoid or segmental resection, between April 2017 and September 2019. Presurgical TVS was performed to evaluate the LAVD in two ways, depending on the level of the lesion. Method 1: for lesions at the level of the rectovaginal septum (RVS), the caudal part of the lesion was identified on TVS and an index finger was placed on the TVS probe at the level of the anal verge. The probe was withdrawn and the distance from the tip of the TVS probe down to the index finger was measured using a ruler, representing the LAVD. Method 2: for lesions above the RVS, the distance between the caudal part of the lesion and the lower lip of the posterior cervix was measured in a frozen image (LAVD‐1), and the distance between the lower lip of the posterior cervix and the anal verge (LAVD‐2) was measured using Method 1. These two measurements (LAVD‐1 and LAVD‐2) were added together and the result represented the total LAVD. During surgery, a rectal probe was used to perform IOM of LAVD, which was considered as the gold standard test. Agreement between LAVD measured using TVS and the IOM was assessed using Bland–Altman analysis. The intraclass correlation coefficient (ICC) for absolute agreement and Spearman's correlation coefficient were also calculated. Systematic and proportional bias were tested for significance using the paired t‐test. Similar analysis was performed to assess agreement between LAVD measured using TVS and anastomosis height. Results A total of 147 consecutive women were considered eligible for inclusion. Fourteen women were excluded initially. Thirty‐four discoid resections and 102 segmental resections were performed; both procedures were performed in three women. Two more women were excluded from the final analysis because the measurements represented extreme outliers. The mean LAVD measured using TVS was 114.8 ± 36.5 mm and the mean IOM was 116.9 ± 42.3 mm. There was no statistically significant difference between LAVD measured using TVS and IOM (mean difference, –2.12 mm (95% CI, –6.33 to 2.05 mm); P = 0.32). Bland–Altman analysis showed that there was good agreement between the two methods. The ICC was 0.81 (95% CI, 0.74–0.86) and Spearman's correlation coefficient was 0.68 (95% CI, 0.56–0.77). The mean difference between LAVD measured using TVS and anastomosis height was statistically, but not clinically, significant (mean difference, 10.25 mm (95% CI, 5.94–14.32 mm); P = 0.0005), and the ICC was 0.78 (95% CI, 0.66–0.85). Conclus...

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Conservative treatment of rectosigmoid endometriosis: A prospective study

Cited by 13 publications

References 29 publications

Advances in the medical management of bowel endometriosis

Advances in the medical management of bowel endometriosis

Transvaginal Sonographic Imaging and Associated Techniques for Diagnosis of Ovarian, Deep Endometriosis, and Adenomyosis: A Comprehensive Review

Transvaginal sonography accurately measures lesion‐to‐anal‐verge distance in women with deep endometriosis of the rectosigmoid

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