OC22.03: The relationship between gastrointestinal symptoms and ultrasound findings in women with suspected endometriosis: a prospective pilot study

Women with endometriosis often have gastrointestinal complaints (GIC). The aim of this study was to evaluate the relationship between these complaints and findings on transvaginal ultrasound (TVUS). A prospective observational study including women referred to a tertiary referral endometriosis clinic. Women completed a self-reported clinical data survey and gastrointestinal/Irritable bowel syndrome questionnaire and underwent 2D/3D TVUS. Endometriosis was diagnosed based on the presence of ovarian endometriomas, deeply infiltrative endometriotic nodules, signs of pelvic adhesions, or tubal disease. A symptom score was calculated based on reported gastrointestinal symptoms. We included 133 women, age 33.1±7.4 years, BMI 23.3±1.4, nulliparous 57.9%. Symptoms: dysmenorrhea (90.7%), chronic pelvic pain (81.7%), dyspareunia (77.5%), dyschezia (68.5%), hematochezia (16%), analgesic use (67.4%). Findings on TVUS: right endometrioma (15.4%), right adhesions (28.4%), left endometrioma (22.9%), left adhesions (37.5%), kissing ovaries (5.3%), uterosacral ligaments (25.8%), retro-cervical (9.8%), recto-sigmoid (10.5%) nodules, absent sliding sign and pouch of Douglas obliteration (16.7%), no bladder nodules. On TVUS the presence of uterosacral ligament involvement was associated with hematochezia, pain on defecation, harder stools, and chronic abdominal pain; the presence of recto-sigmoid, retro-cervical, or intestinal lesions was associated with increased stool frequency and softer stools; and pouch of Douglas obliteration was associated with a residual feeling after defecation. A higher score on the gastrointestinal symptom questionnaire was associated with pouch of Douglas obliteration and uterosacral ligament involvement on TVUS (all p<0.05). We observed a high prevalence of GIC in women referred to an endometriosis clinic. The presence of GIC should prompt an earlier evaluation for endometriotic lesions, which may potentially reduce the delay in diagnosis in these patients.