OP34.03: Ultrasound‐based clinical history of rectosigmoid deep infiltrating endometriosis: a 10‐year follow‐up study

To observe the clinical history of fertile women with rectosigmoid DIE diagnosed by 3D-TVS. Consecutive fertile women with rectosigmoid DIE were prospectively enrolled for a longitudinal observational study during 01.01.2006 – 31.12.2015. All patients underwent detailed clinical interview, clinical examination, 3D-TVS examination, and Double Contrast Barium Enema (DCBE) in selected cases. 3D-TVS was performed with the GE Voluson 730 and E8 units, using a wide-band 3–9 MHz transducer. Multiplanar display and VCI analysis by 2 mm slices of the acquired 3D volumes was performed to evaluate the depth of bowel wall infiltration. Medical hormone therapy (HT) was proposed as first option in patients referring pain or pain and infertility requiring ART, and consisted of quarterly continuous oral contraceptives or vaginal ring or progestins, or long-term LNG-IUS. Surgery was proposed in patients referring infertility or resistant to HT. Demographic, medical, imaging and surgical data were recorded. Surgery and/or MRI were considered the gold standard in DCBE cases. 223 patients were recruited. Mean age was 35 years (SD ±6). Mean BMI was 22 kg/m2 (SD ± 3). 146 (65%) patients were nulligravid. 182 (82%) patients had a multi-organ abdomino-pelvic disease (2 sites 39%, 3 sites 32%, >3 sites 11%), up to 90% were symptomatic. At an 8-years follow-up period, up to 80% of patients were conservatively managed by HT, with a significant reduction of symptoms and of bowel DIE nodules volume. Bowel resection and shaving was performed in 5 and 9 cases, respectively. In the 60 selected cases, the comparative diagnosis at 3D-TVS and DCBE was good (Weighted Kappa = 0.793). A 3D-TVS-based triage adequately diagnoses rectosigmoid DIE, a strongly symptomatic multi-compartimental disease. Medical treatment should be the first option in the management of patients with symptomatic DIE for an effective and efficient long-term conservative management.