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

Vercellini, Paolo; Buggio, Laura; Borghi, Alessandra; Monti, Ermelinda; Gattei, Umberto; Frattaruolo, Maria Pina

doi:10.1111/aogs.13328

Cited by 27 publications

(16 citation statements)

References 59 publications

(141 reference statements)

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“…It has been previously reported that hormonal therapies can decrease the size of deep endometriotic nodules [18,30]; however, it seems that there is no direct correlation between improvement of symptoms and decrease in nodule volume [30]. In our study, at the end of follow-up visits under DNG therapy, a mean nodule volume reduction of at least 10% was reported by around 30% of women.…”

Section: Discussioncontrasting

confidence: 65%

“…The diagnosis of rectosigmoid endometriosis was based on transvaginal ultrasonography (TVS). Only women with endometriotic nodules infiltrating at least the muscular layer of the rectal wall and with an estimated stenosis of the bowel lumen <60% were considered eligible to be treated by hormonal therapy, as previously suggested [18]. Although some of the patients included in the study had previously undergone laparoscopy for endometriosis, none of them had previous bowel surgery (with the exception of appendectomy).…”

Section: Study Populationmentioning

confidence: 99%

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Long-Term Administration of Dienogest for the Treatment of Pain and Intestinal Symptoms in Patients with Rectosigmoid Endometriosis

Barra

Scala

Maggiore

et al. 2020

JCM

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Background: Rectosigmoid endometriosis is a severe form of deep endometriosis, which may be responsible for pain symptoms and a wide range of intestinal complains such as diarrhea, constipation, and abdominal cramping. The primary objective of this study was to evaluate the efficacy of long-term therapy with dienogest (DNG), a fourth-generation progestin, for ameliorating quality of life, pain, and intestinal symptoms of patients affected by rectosigmoid endometriosis. Methods: A retrospective analysis of a prospectively collected database was done on patients with endometriotic nodules infiltrating at least the muscular layer of the rectosigmoid wall with an estimated colorectal stenosis <60%. The diagnosis of rectosigmoid endometriosis was based on transvaginal ultrasonography. Patients accepting to participate in the study received continuous oral treatment with DNG at the dose of 2 mg/day. Results: At the end of the first year of treatment, a significant decrease in dysmenorrhea (P < 0.001), chronic pelvic pain (P < 0.001), dyspareunia (P < 0.001), dyschezia (P < 0.001), and in intestinal symptoms (P < 0.001) was observed. A progressive increase of the Endometriosis Health Profile-30 (EHP-30) and Gastrointestinal Quality of Life Index (GIQLI) scores was observed in the first two years of therapy (P < 0.001 and P < 0.001, respectively). Improvements of patients’ symptoms and quality of life were maintained until the end of the study. The regimen was well tolerated, and the frequency and amount of irregular bleeding decreased as treatment progressed. Conclusion: The current study confirms the efficacy of long-term therapy with DNG for treating symptoms caused by rectosigmoid endometriosis.

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Section: Discussioncontrasting

confidence: 65%

Section: Study Populationmentioning

confidence: 99%

Long-Term Administration of Dienogest for the Treatment of Pain and Intestinal Symptoms in Patients with Rectosigmoid Endometriosis

Barra

Scala

Maggiore

et al. 2020

JCM

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“…Probably due to local anatomical and physiological factors, endometriotic lesions of the left colon are much more frequent than those infiltrating the right colon [2]. Left lesions comprise those involving the rectosigmoid junction (proximal rectum plus distal sigmoid) and those above the rectosigmoid junction (nodules of the mid-and proximal sigmoid) [19,20]. Right infiltrating lesions generally involve the terminal ileum and the cecum.…”

Section: Anatomical and Histological Premisesmentioning

confidence: 99%

“…Decreased libido (19) Vaginal dryness (12) At Spotting (11) Breast tenderness (6) Bloating 5Headache 4Depression 4Nausea ( Weight gain (16) Spotting (13) Decreased libido (9) Vaginal dryness 7Bloating (6) Similar satisfaction with treatment and pain relief. Alopecia 5Headache 3Mood disorders (2) Breast tenderness 1Nausea 1Breakthrough bleeding…”

Section: Sourcementioning

confidence: 99%

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

Cited by 27 publications

References 59 publications

Long-Term Administration of Dienogest for the Treatment of Pain and Intestinal Symptoms in Patients with Rectosigmoid Endometriosis

Long-Term Administration of Dienogest for the Treatment of Pain and Intestinal Symptoms in Patients with Rectosigmoid Endometriosis

Advances in the medical management of bowel endometriosis

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

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