Continuous Amenorrhea May Be Insufficient to Stop the Progression of Colorectal Endometriosis

Millochau, Jenny-Claude; Abo, Carole; Darwish, Basma; Huet, Emmanuel; Dietrich, Gauthier; Roman, Horace

doi:10.1016/j.jmig.2016.04.008

Cited by 24 publications

(16 citation statements)

References 12 publications

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“…Recently, Casper questioned the role of OCs in the management of endometriosis based on the hypothesis that, owing to the supra-physiologic estrogen content, these combinations may not adequately suppress lesions and control symptoms (46). Although some literature data suggest that OCs may be safely used in women with colorectal endometriosis (12,29), bowel occlusion during treatment with estrogen-progestin combinations has been reported (38). Therefore, when treating women with symptomatic intestinal endometriosis, it may be wiser to use progestin monotherapies rather than OCs to minimize the risk of occlusion, (31).…”

Section: Discussionmentioning

confidence: 99%

“…At the 1-year evaluation, 18 patients (69%) were satisfied or very satisfied with their treatment, four were uncertain, and four were dissatisfied or very dissatisfied. Millochau et al (38) reported the case of a woman treated with estrogen-progestin combinations for an isolated nodule of the sigmoid colon that grew during a 4-year medical treatment, causing occlusive symptoms and necessitating surgery.…”

Section: Estrogen-progestins and Progestinsmentioning

confidence: 99%

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Medical treatment in the management of deep endometriosis infiltrating the proximal rectum and sigmoid colon: a comprehensive literature review

Vercellini

Buggio

Borghi

et al. 2018

Acta Obstet Gynecol Scand

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A comprehensive literature review was performed to evaluate the effect of various hormonal therapies, in terms of variations of intestinal and pain complaints and of patient satisfaction with treatment, in women with symptomatic, non-severely sub-occlusive endometriosis infiltrating the proximal rectum and sigmoid colon. A MEDLINE search through PubMed from 2000 to 2018 was conducted to identify all original English language articles published on medical treatment for colorectal endometriosis. Additional reports were identified by systematically reviewing reference lists and using the "similar articles" function in PubMed. A total of 420 women with colorectal endometriosis treated with combined oral contraceptives, progestins, gonadotropin releasing-hormone (GnRH) agonists and aromatase inhibitors have been described in eight case series, two retrospective cohort studies and four case reports. Published data consistently suggest that several hormonal medications can control most symptoms associated with intestinal endometriosis, provided the relative bowel lumen stenosis is less than 60%. Patients with irritative-type symptoms appear to respond better than those with constipation. Overall, about two-thirds of women were satisfied with the treatment received, independently of the drug used. Progestins are the compound supported by the largest body of evidence. The addition of aromatase inhibitors or, alternatively, the use of GnRH agonists does not seem to be associated with better outcomes. Long-term treatment with a progestin should be proposed as an alternative to surgery to patients with non-severely sub-occlusive endometriosis infiltrating the proximal rectum and sigmoid colon who are not seeking conception. The final decision should be shared together with the woman, respecting her preferences and priorities.

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Section: Discussionmentioning

confidence: 99%

Section: Estrogen-progestins and Progestinsmentioning

confidence: 99%

Medical treatment in the management of deep endometriosis infiltrating the proximal rectum and sigmoid colon: a comprehensive literature review

Vercellini

Buggio

Borghi

et al. 2018

Acta Obstet Gynecol Scand

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“…We were therefore unable to confirm earlier findings that growth of rectosigmoid endometriosis should be accompanied by pain as suggested in previous reports. 16,28 Our data on size and growth of rectosigmoid nodules should, however, be considered in light of the intraobserver variability associated with TVS measurement of rectosigmoid DIE, 23 where large intra-and interobserver variations have been shown in a recent study. Still, the present results suggest a low risk of progression and bowel obstruction but longer follow-up on larger study-groups is needed to assess the occurrence of this complication.…”

Section: Accepted Articlementioning

confidence: 79%

“…12 However, these patients may face major problems. Thus, conservative treatment implies a risk of disease progression ultimately leading to bowel obstruction, [13][14][15][16] and therefore patients must be followed clinically 17 to detect worsening of pain and bowel symptoms. The impact of medical therapy on this process remains to be elucidated.…”

Section: Introductionmentioning

confidence: 99%

Conservative treatment of rectosigmoid endometriosis: A prospective study

Egekvist

Marinovskij

Forman

et al. 2019

Acta Obstet Gynecol Scand

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Introduction: Deep infiltrating endometriosis is a common cause of pelvic pain. However, some patients have limited problems that may be controlled by medical treatment, thus avoiding potentially severe complications to major surgery. This approach requires detailed knowledge on the quality of life and clinical symptoms over time. The aim of the study was therefore to monitor these parameters in patients with rectosigmoid endometriosis treated with oral contraceptives, oral gestagens and /or the levonorgestrel-releasing intrauterine device. Moreover, nodule size measurements performed with transvaginal sonography were correlated to severity of symptoms. Material and methods: Conservatively treated patients on oral contraceptives, oral gestagens, or the levonorgestrel-releasing intrauterine device underwent transvaginal sonography and answered a self-administered questionnaire regarding clinical symptoms and quality of life (Short Form 36 and Endometriosis Health Profile 30) at baseline, and six and 12 months later. Results: Eighty women completed the follow-up. Scores of quality of life were comparable to normative data for Danish women of similar age and did not change with time. No association between change in size of the rectosigmoid nodule and change in symptoms was seen. Conclusions: This study supports that simple treatment with oral contraceptives, oral gestagens, or the levonorgestrel-releasing intrauterine device represents a viable therapeutic approach to rectosigmoid deep infiltrating endometriosis, provided that proper selection of patients in need of surgery exists.

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“…Importantly, women undergoing clinical treatment must follow up closely with specialists and the clinical aspects as well as imaging exams (TUS or MRI) should be repeated every year. As recently reported, medical (hormonal) treatment leading to continuous amenorrhea may be insufficient to stop the progression of colorectal endometriosis as related in a case report 58 and therefore, clinicians should keep a close follow-up for patients with bowel endometriosis undergoing clinical treatment. On the other hand, a prospective observational study evaluated 26 patients with bowel endometriosis treated with low-dose oral contraceptive for 12 months; after this period, authors reported a significant improvement in all related symptoms (dysmenorrhea, acyclic pelvic pain, dyspareunia, painful defecation) as well as a reduction in the diameter and volume of the nodules in the bowel.…”

Section: Clinical Treatmentmentioning

confidence: 82%

Strategies for Management of Colorectal Endometriosis

Abrão

Borrelli

Clarizia³

et al. 2016

Semin Reprod Med

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Endometriosis has clearly three distinct clinical presentations and deep endometriosis, especially compromising the rectosigmoid is probably the most concerning one for both patients and surgeons. Currently, with the available tools, it is mandatory to have a precise diagnostic of this type of disease prior to indication of treatment. Strategies to manage this form of endometriosis will take into account several involved aspects, such as age of the patient, reproductive desire or infertility, clinical symptoms, as well as the extension and localization of the disease. Treatment could vary from more conservative to more radical depending on those aspects. As we pointed out in this article, the key to manage colorectal endometriosis is to start with a good diagnosis. Knowing exactly what is the extension and localization of the disease and knowing the patient's wishes as well as the clinical complaints, surgeons are able to define the best option for each patient. Critical points should always be discussed; for example, patients chosen to have clinical treatment should be aware of important issues regarding the follow-up, while patients undergoing surgery must be advised about all surgical possibilities and related complications.

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Continuous Amenorrhea May Be Insufficient to Stop the Progression of Colorectal Endometriosis

Cited by 24 publications

References 12 publications

Medical treatment in the management of deep endometriosis infiltrating the proximal rectum and sigmoid colon: a comprehensive literature review

Medical treatment in the management of deep endometriosis infiltrating the proximal rectum and sigmoid colon: a comprehensive literature review

Conservative treatment of rectosigmoid endometriosis: A prospective study

Strategies for Management of Colorectal Endometriosis

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