Transvaginal sonography with <i>vs</i> without bowel preparation in diagnosis of rectosigmoid endometriosis: prospective study

Ferrero, Simone; Scala, Carolina; Stabilini, Cesare; Vellone, Valerio Gaetano; Barra, Fabio; Maggiore, Umberto Leone Roberti

doi:10.1002/uog.19194

Cited by 23 publications

(17 citation statements)

References 37 publications

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“…Moreover, Ferrero et al . 's sensitivity and specificity with and without bowel preparation 17 was lower compared with previously published values 12,13,16 , suggesting that the methodological approach of those studies could have been different.…”

Section: Discussioncontrasting

confidence: 55%

“…In particular, we found that up to 55% of the patients who were identified by TVS without bowel preparation as having adhesions to the serosal layer were evaluated as having rectosigmoid nodules on TVS with prior bowel preparation. Moreover, Ferrero et al's sensitivity and specificity with and without bowel preparation 17 was lower compared with previously published values 12,13,16 , suggesting that the methodological approach of those studies could have been different.…”

Section: Discussionmentioning

confidence: 68%

“…Conversely, Ferrero et al 17 . suggested that bowel preparation does not increase accuracy in detecting rectosigmoid lesions; however, they considered only endometriotic lesions infiltrating at least as far as the intestinal muscularis propria 17 , while our study also considered lesions involving the serosa, i.e. adhesions.…”

Section: Discussionmentioning

confidence: 78%

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Bowel preparation prior to transvaginal ultrasound improves detection of rectosigmoid deep infiltrating endometriosis and is well tolerated: prospective study of women with suspected endometriosis without surgical criteria

Ros

Rius

Abrão

et al. 2021

Ultrasound in Obstet & Gyne

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Objectives To analyze the effect of bowel preparation prior to transvaginal ultrasound (TVS) examination on the detection of bowel involvement and the description of rectosigmoid nodules of deep infiltrating endometriosis (DIE), and to evaluate patient tolerance of bowel preparation. Methods This was a prospective study of paired data obtained between September 2015 and March 2016 from a cohort of women referred, on suspicion of DIE but without surgical criteria, to the endometriosis unit of a tertiary university hospital. In all patients, the wall of the rectum and lower sigmoid colon was evaluated by two TVS examinations: the first was performed without bowel preparation and the second was done after the patient had followed a 3‐day low‐residue diet and received two 250‐mL enemas, one the night before TVS and the second 1–3 h before the examination. The presence of adhesions, number and size of rectosigmoid nodules, deepest layer of the rectum affected, percentage of the circumference of the bowel affected and distance from the most caudal part of the bowel nodule to the anal verge were determined. Patient tolerance to bowel preparation was assessed using a 5‐point Likert scale, in which 1 represented ‘very well tolerated’ and 5 represented ‘very poorly tolerated’. Results The mean ± SD age of the 110 patients included in the study was 36.8 ± 5.07 years. As many as 55% of those identified during the first examination (TVS alone) as having adhesions were identified at the second examination (TVS with prior bowel preparation) as having rectosigmoid nodules, and 22 additional nodules were observed on TVS following bowel preparation. These newly detected rectosigmoid nodules, initially assessed mainly as adhesions, were smaller and more superficial compared with the nodules detected on TVS alone, or located in the anterior sigmoid wall. Patient tolerance overall to bowel preparation scored a mean of 1.81 on the 5‐point Likert scale. Conclusions Bowel preparation is well tolerated by patients. When bowel preparation is performed before TVS, the detection of small and superficial nodules and those in the anterior sigmoid wall is improved, allowing more detailed description of these nodules in patients with suspected endometriosis. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 68%

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Bowel preparation prior to transvaginal ultrasound improves detection of rectosigmoid deep infiltrating endometriosis and is well tolerated: prospective study of women with suspected endometriosis without surgical criteria

Ros

Rius

Abrão

et al. 2021

Ultrasound in Obstet & Gyne

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“…100,101 Nevertheless, similar diagnostic performance has been found without bowel preparation 89 and a recent study could not demonstrate improvement in detecting rectosigmoid DE using bowel preparation with an accuracy of 93.5% (95% CI, 89.8-96.2) versus no bowel preparation of 92.4% (95% CI, 88.5-95.3). 102 Examiners are recommended to perform a comprehensive clinical history and TVS examination of the pelvis in all women presenting with pelvic pain. However, the "sliding sign" and bilateral endometriomas can aid imaging with TVS and diagnosis of potential DE of the rectosigmoid.…”

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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“…Over the last ten years, several ultrasonographic techniques based on the distention of the vagina and/or rectosigmoid with saline solution and/or ultrasonographic gel have been proposed with the aim of improving the diagnosis of deep infiltrating endometriosis [12]. Among the others, rectal water contrast transvaginal ultrasonography (RWC-TVS) has been employed in this setting, demonstrating a high accuracy in ruling out the presence of rectosigmoid endometriosis [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

A Prospective Study Comparing Three-Dimensional Rectal Water Contrast Transvaginal Ultrasonography and Computed Tomographic Colonography in the Diagnosis of Rectosigmoid Endometriosis

et al. 2020

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(1) Objectives: In patients with symptoms suggestive of rectosigmoid endometriosis, imaging techniques are required to confirm the presence and establish the extent of the disease. The objective of the current study was to compare the performance of three-dimensional rectal water contrast transvaginal ultrasonography (3D-RWC-TVS) and computed tomographic colonography (CTC) in predicting the presence and characteristics of rectosigmoid endometriosis. (2) Methods: This prospective study included patients with suspicion of rectosigmoid endometriosis who underwent both 3D-RWC-TVS and CTC and subsequently were surgically treated. The findings of imaging techniques were compared with surgical and histological results. (3) Results: Out of 68 women included in the study, 37 (48.9; 95% C.I. 38.2–59.7%) had rectosigmoid nodules and underwent bowel surgery. There was no significant difference in the accuracy of 3D-RWC-TVS and CTC in diagnosing the presence of rectosigmoid endometriotic nodules (p = 0.118), although CTC was more precise in diagnosing endometriosis located in the sigmoid (p = 0.016). 3D-RWC-TVS and CTC had similar precision in estimating the largest diameter of the main endometriotic nodule (p = 0.099) and, in patients undergoing segmental resection, the degree of the stenosis of the bowel lumen (p = 0.293). CTC was more accurate in estimating the distance between the lower margin of the intestinal nodule and the anal verge (p = 0.030) but was less tolerated than 3D-RWC-TVS (p < 0.001). (4) Conclusion: This was the first study comparing the performance of 3D-RWC-TVS and CTC in the diagnosis of rectosigmoid endometriosis. Both techniques allowed for the evaluation of the profile of the bowel lumen in a pseudoendoscopic fashion and had a similar performance for the diagnosis of rectosigmoid endometriosis, although CTC was more accurate in diagnosing and characterizing sigmoid nodules.

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Transvaginal sonography with vs without bowel preparation in diagnosis of rectosigmoid endometriosis: prospective study

Abstract: BP does not increase the diagnostic performance of TVS in detecting rectosigmoid endometriosis and in assessing the characteristics of these nodules. This article is protected by copyright. All rights reserved.

Cited by 23 publications

References 37 publications

Bowel preparation prior to transvaginal ultrasound improves detection of rectosigmoid deep infiltrating endometriosis and is well tolerated: prospective study of women with suspected endometriosis without surgical criteria

Bowel preparation prior to transvaginal ultrasound improves detection of rectosigmoid deep infiltrating endometriosis and is well tolerated: prospective study of women with suspected endometriosis without surgical criteria

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

A Prospective Study Comparing Three-Dimensional Rectal Water Contrast Transvaginal Ultrasonography and Computed Tomographic Colonography in the Diagnosis of Rectosigmoid Endometriosis

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