The role of imaging as a guide to the surgical treatment of endometriosis

Burnett, Tatnai L.; Feldman, Myra K.; Huang, Jian

doi:10.1007/s00261-019-02399-0

Cited by 10 publications

(7 citation statements)

References 35 publications

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“…Use of pre-operative imaging may also help educate patients and allow them to participate in shared decision-making for high-impact decisions. 22,23…”

Section: Discussionmentioning

confidence: 99%

“…Use of pre-operative imaging may also help educate patients and allow them to participate in shared decision-making for high-impact decisions. 22,23 Our study is limited by its retrospective design and associated risk of bias, however given prospective collection of patient symptoms through a standardized instrument this risk is minimized. Patients included were undergoing care at a single academic referral center, potentially introducing selection bias that may limit generalizability of results.…”

Section: Discussionmentioning

confidence: 99%

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Gastrointestinal symptoms as a predictor of deep endometriosis of the pelvic posterior compartment on magnetic resonance imaging

Fadadu

Cope

Weng

et al. 2022

Journal of Endometriosis and Pelvic Pain Disorders

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Objective: To determine if gastrointestinal (GI) symptoms can predict deep endometriosis (DE) of the posterior pelvic compartment on magnetic resonance imaging (MRI). Methods: Patients with suspected endometriosis undergoing endometriosis protocol MRI at an academic center between 9/1/2015 and 7/31/2018 were identified. Presenting GI symptoms were collected via a standardized survey instrument prospectively at initial presentation. MRI and interdisciplinary conference notes were reviewed to identify posterior compartment DE (rectosigmoid, uterosacral ligaments, posterior cul de sac, and pelvic side walls). Associations between symptoms and DE were evaluated. Results: A total of 104 patients met inclusion criteria, and 89 (85.6%) presented with at least one GI symptom. Posterior compartment DE was identified on MRI in 47 patients (45.2%). The GI symptom that most strongly predicted DE was a bowel movement resulting in pain relief (OR 3.36, 95% CI 1.31–8.61, p = 0.012), with sensitivity, specificity, positive and negative predictive values 0.42, 0.82, 0.67, and 0.63, respectively. Other GI symptoms such as nausea, vomiting, rectal bleeding, change in frequency of bowel movements, and pain exacerbation by bowel movements did not significantly correlate to having DE. Of the 15 patients with no GI symptoms, 5 were found to have posterior compartment DE. Conclusion: In patients with suspected endometriosis, those who noted that bowel movements relieved their pain had more than three times the odds of having DE of the posterior compartment on MRI. Preoperative evaluation with MRI may be of value in these patients; however, lack of gastrointestinal symptoms does not exclude the possibility of posterior compartment DE.

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“…Use of pre-operative imaging may also help educate patients and allow them to participate in shared decision-making for high-impact decisions. 22,23…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Gastrointestinal symptoms as a predictor of deep endometriosis of the pelvic posterior compartment on magnetic resonance imaging

Fadadu

Cope

Weng

et al. 2022

Journal of Endometriosis and Pelvic Pain Disorders

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“…6 Planning for surgical management of endometriosis, especially complex endometriosis, therefore, requires preoperative planning with cooperation between gynecologic surgeon and radiologist. 6,8 Targeted endometriosis transvaginal ultrasound protocols specifically assessing for adhesions in the posterior cul de sac and magnetic resonance imaging remain the most used modalities, and both demonstrate high sensitivity and specificity for endometriomas and deep endometriosis. 6,9 Preoperative preparation allows for the patient to be counseled on disease severity, expectations, possible risks, and outcomes, as well as assembly of appropriate multidisciplinary teams including colorectal and urologic surgeons.…”

Section: Outcomes Of Surgical Therapymentioning

confidence: 99%

“…5 Historically, diagnostic laparoscopic was the gold standard for diagnoses of endometriosis, commonly resulting in incomplete treatment, with most patients undergoing a subsequent surgical treatment. [5][6][7] Diagnostic laparoscopy can be hindered by the possible unexpected finding of severe endometriosis, and in turn, contribute to possible suboptimal treatment outcomes. 6 Planning for surgical management of endometriosis, especially complex endometriosis, therefore, requires preoperative planning with cooperation between gynecologic surgeon and radiologist.…”

Section: Outcomes Of Surgical Therapymentioning

confidence: 99%

“…[5][6][7] Diagnostic laparoscopy can be hindered by the possible unexpected finding of severe endometriosis, and in turn, contribute to possible suboptimal treatment outcomes. 6 Planning for surgical management of endometriosis, especially complex endometriosis, therefore, requires preoperative planning with cooperation between gynecologic surgeon and radiologist. 6,8 Targeted endometriosis transvaginal ultrasound protocols specifically assessing for adhesions in the posterior cul de sac and magnetic resonance imaging remain the most used modalities, and both demonstrate high sensitivity and specificity for endometriomas and deep endometriosis.…”

Section: Outcomes Of Surgical Therapymentioning

confidence: 99%

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Persistent Pelvic Pain in Patients With Endometriosis

Green

Burnett

Famuyide

2022

Clinical Obstetrics &Amp; Gynecology

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As our understanding of chronic pain conditions, including endometriosis-related pain and chronic pelvic pain evolves, the evaluation and management of patients should reflect our increasing appreciation of the role of central sensitization, comorbid conditions and biopsychosocial factors on the pain experience and treatment outcomes. This review provides a systematic approach to persistent pain in patients with endometriosis. Expanding the evaluation and treatment of endometriosis-related pain by all health care providers could limit unnecessary surgical interventions and best meet our patient's needs.

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