Deep endometriosis — a comparative study of pain syndrome and the prevalence of clinical symptoms according to the #ENZIAN classification

Elena M. Ivanova, Nadejda Codreanu
In: Russian Journal of Human Reproduction · 2025 · vol. 31(4) , pp. 96 · doi:10.17116/repro20253104196 · W4414130491
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This study found that deep infiltrating endometriosis patients exhibit greater pain intensity and a broader spectrum of symptoms compared to other endometriosis forms, with symptoms correlating to #ENZIAN classification compartments.

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The paper studied deep endometriosis pain and the prevalence of clinical symptoms, comparing these features across categories of the #ENZIAN classification. It used a high-level comparative analysis of women classified by #ENZIAN to relate lesion distribution/staging to reported pain syndrome and symptom frequency. The key finding reported differences in pain and symptom prevalence by #ENZIAN class, supporting the classification’s utility for symptom characterization, with the main limitation being the framing around a clinical classification that may not fully capture all contributors to symptoms. This paper is centrally about endometriosis — it directly evaluates pain and clinical symptom prevalence in deep endometriosis using the #ENZIAN classification.

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Abstract

Deep infiltrating endometriosis (DIE) is the most aggressive and heterogeneous form of endometriosis, constituting 25% of the latter. The diagnosis of DIE presents a complex challenge in the medicine. The #ENZIAN classification, approved for clinical application, serves as a fundamental tool for diagnosing DIE. Objective. Comparation of the pain syndrome among forms of endometriosis, examination of DIE symptoms according to the #ENZIAN for improving its preoperative diagnostic. Methodology. A cohort study conducted at the G. Paladi Municipal Hospital in Chisinau during 2 years, included 190 reproductive-aged patients with endometriosis, divided into cohorts according to the #ENZIAN classification: the principal — 85 patients with DIE, the comparative — 105 women with alternative forms of endometriosis. Visual Analog Scale (VAS) and the Biberoglu and Behrman (B&B) scale were deployed for objectivization of pelvic pain. The study analyzed the correlation between the symptoms of DIE and the localization of lesions by the #ENZIAN. Statistical analyses were executed in the SPSS. Results. The intensity of the pain by VAS and B&B in patients with DIE surpassed the control cohort (p7 points) and broader spectrum of pain (dysuria, dyschezia), catamenial extragenital symptoms (p<0.001). The symptomatic analysis of DIE demonstrated a statistical correlation with specific #ENZIAN compartments (p<0.05). Conclusions. A high-intensity and broad-spectrum pelvic pain syndrome, combined with extragenital symptoms, are fundamental aspects of the clinical diagnosis of DIE. The #ENZIAN classification, which correlates with the symptoms of the pathology, represents a reliable method for non-invasive multidisciplinary diagnosis of DIE and planning its surgical treatment within a multidisciplinary team of specialists.
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Сайт издательства «Медиа Сфера» содержит материалы, предназначенные исключительно для работников здравоохранения. Закрывая это сообщение, Вы подтверждаете, что являетесь дипломированным медицинским работником или студентом медицинского образовательного учреждения. Результаты поиска: 0 Глубокий эндометриоз — сравнительное исследование болевого синдрома и распространенности клинических симптомов согласно классификации #ENZIAN Журнал: Проблемы репродукции. 2025;31(4): 96‑101 Прочитано: 873 раза Как цитировать: Литература / References: - Donnez O. Conservative Management of Rectovaginal Deep Endometriosis: Shaving Should Be Considered as the Primary Surgical Approach in a High Majority of Cases. Journal of Clinical Medicine. 2021;10(21):5183. https://doi.org/10.3390/jcm10215183 - Imperiale L, Nisolle M, Noël JC, Fastrez M. Three Types of Endometriosis: Pathogenesis, Diagnosis and Treatment. State of the Art. Journal of Clinical Medicine. 2023;12(3):994. https://doi.org/10.3390/jcm12030994 - Wild M, Miskry T, Al-Kufaishi A, Rose G, Crofton M. Medical management of deeply infiltrating endometriosis — 7 year experience in a tertiary endometriosis centre in London. Gynecological Surgery. 2019;16(1):1-7. https://doi.org/10.1186/s10397-019-1065-9 - Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, King K, Kvaskoff M, Nap A, Petersen K, Saridogan E, Tomassetti C, van Hanegem N, Vulliemoz N, Vermeulen N; ESHRE Endometriosis Guideline Group. ESHRE guideline: endometriosis. Human Reproduction Open. 2022;2022(2):hoac009. https://doi.org/10.1093/hropen/hoac009 - Working group of ESGE, ESHRE, and WES; Keckstein J, Becker CM, Canis M, Feki A, Grimbizis GF, Hummelshoj L, Nisolle M, Roman H, Saridogan E, Tanos V, Tomassetti C, Ulrich UA, Vermeulen N, De Wilde RL. Recommendations for the surgical treatment of endometriosis. Part 2: deep endometriosis. Human Reproduction Open. 2020;2020(1):hoaa002. https://doi.org/10.1093/hropen/hoaa002 - Bazot M, Bharwani N, Huchon C, Kinkel K, Cunha TM, Guerra A, Manganaro L, Buñesch L, Kido A, Togashi K, Thomassin-Naggara I, Rockall AG. European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis. European Radiology. 2017;27(7):2765-2775. https://doi.org/10.1007/s00330-016-4673-z - Hernández Cardona MI, Ajewole C, Lewis H, Carrillo JF, Castellanos ME, Barish S, Villegas Echeverri JD, Lamvu G. Time to move beyond surgical classification systems for endometriosis. International Journal of Gynaecology and Obstetrics. 2023;163(1):58-62. https://doi.org/10.1002/ijgo.14786 - Oral E, Aydin O, Kumbak BA, İlvan S, Yilmaz H, Tustas E, Bese T, Demirkiran F, Arvas M. Concomitant endometriosis in malignant and borderline ovarian tumours. 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World endometriosis society consensus on the classification of endometriosis. Human Reproduction. 2017;32(2):315-324. https://doi.org/10.1093/humrep/dew293 - Keckstein J, Hudelist G. Classification of deep endometriosis (DE) including bowel endometriosis: From r-ASRM to #Enzian-classification. Best Practice and Research. Clinical Obstetrics and Gynaecology. 2021;71:27-37. https://doi.org/10.1016/j.bpobgyn.2020.11.004 - Koninckx PR, Ussia A, Gordts S, Keckstein J, Saridogan E, Malzoni M, Stepanian A, Setubal A, Adamyan L, Wattiez A. The 10 «Cardinal Sins» in the Clinical Diagnosis and Treatment of Endometriosis: A Bayesian Approach. Journal of Clinical Medicine. 2023;12(13):4547. https://doi.org/10.3390/jcm12134547 - Enzelsberger SH, Oppelt P, Nirgianakis K, Seeber B, Drahoňovský J, Wanderer L, Krämer B, Grübling KN, Kundu S, Salehin D, Mierzwinski M, Krentel H, Hermann P, Wagner H, Shebl O, Schäfer S. Preoperative application of the Enzian classification for endometriosis (The cEnzian Study): A prospective international multicenter study. BJOG. 2022;129(12):2052-2061. https://doi.org/10.1111/1471-0528.17235 - Roman H; FRIENDS group (French coloRectal Infiltrating ENDometriosis Study group). A national snapshot of the surgical management of deep infiltrating endometriosis of the rectum and colon in France in 2015: A multicenter series of 1135 cases. Journal of Gynecology Obstetrics and Human Reproduction. 2017;46(2):159-165. https://doi.org/10.1016/j.jogoh.2016.09.004 Подтверждение e-mail На [email protected] отправлено письмо со ссылкой для подтверждения e-mail. Перейдите по ссылке из письма, чтобы завершить регистрацию на сайте. Подтверждение e-mail Мы используем файлы cооkies для улучшения работы сайта. Оставаясь на нашем сайте, вы соглашаетесь с условиями использования файлов cооkies. 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Outcome instruments

VAS-pain Enzian Biberoglu-Behrman

Condition tags

endometriosisdie_deep_infiltrating

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