Clinical and Sonographic Progression of Bowel Endometriosis: 3-Year Follow-up

The aim of this study was to evaluate progression of the bowel endometriosis lesion over time. We performed a retrospective cohort with 164 patients with rectosigmoid endometriosis identified by transvaginal ultrasound (TVUS) with bowel preparation waiting for surgical treatment. Length and circumference of the bowel lesion evaluated by TVUS, painful symptoms (dysmenorrhea, dyspareunia, noncyclic pelvic pain, dyschezia, dysuria), and menopausal status were assessed at baseline and 6, 12, 24, 36, and > 36 months. A linear mixed model was used and p values < 0.05 were considered significant. We considered the length and the circumference as the main parameter; the characteristics were considered as fixed effects and the patient as random effect. This model allows to deal with missing data from longitudinal studies. All painful symptoms significantly improved during follow-up. Overall, the mean length and circumference of the greatest bowel lesion were 2.9 ± 1.8 cm and 27 ± 10%, respectively, and those did not change over time (p > 0.05). Patients with severe dyspareunia had significant greater circumference (p = 0.037) and those with severe dyschezia had significant greater length (p = 0.047) of bowel lesions. Symptoms were not related with progression of the lesion over time. The bowel lesion length significantly decreased over time in patients in menopause (p = 0.009). There was no difference in the bowel lesion length between patients with and without hormonal treatment (p > 0.05). The results suggest that bowel endometriosis does not increase over time during reproductive age and reduces after menopause. Symptoms are also not related to the bowel lesion progression. Similar content being viewed by others Data Availability Data is available offline.

Vercellini P, Buggio L, Borghi A, Monti E, Gattei U, Frattaruolo MP. Medical treatment in the management of deep endometriosis infiltrating the proximal rectum and sigmoid colon: a comprehensive literature review. Acta Obstet Gynecol Scand. 2018;97:942–55. Abrão MS, Petraglia F, Falcone T, Keckstein J, Osuga Y, Chapron C. Deep endometriosis infiltrating the recto-sigmoid: critical factors to consider before management. Hum Reprod Update. 2015;21(3):329–39. Berlanda N, Somigliana E, Frattaruolo MP, Buggio L, Dridi D, Vercellini P. Surgery versus hormonal therapy for deep endometriosis: is it a choice of the physician? Eur J Obstet Gynecol Reprod Biol. 2016. Andres MP, Mendes RFP, Hernandes C, Araújo SEA, Podgaec S. Hormone treatment as first line therapy is safe and relieves pelvic pain in women with bowel endometriosis. Einstein (Sao Paulo). 2019;17(2):eAO4583. Vercellini P, Frattaruolo MP, Rosati R, Dridi D, Roberto A, Mosconi P, et al. Medical treatment or surgery for colorectal endometriosis? Results of a shared decision-making approach. Hum Reprod. 2018;33(2):202–11. Netter A, d’Avout-Fourdinier P, Agostini A, Chanavaz-Lacheray I, Lampika M, Farella M, et al. Progression of deep infiltrating rectosigmoid endometriotic nodules. Hum Reprod. 2019;34(11):2144–52. Goncalves MO, Podgaec S, Dias JA, Gonzalez M, Abrao MS. Transvaginal ultrasonography with bowel preparation is able to predict the number of lesions and rectosigmoid layers affected in cases of deep endometriosis, defining surgical strategy. Hum Reprod. 2010;25(3):665–71. Bourdel N, Alves J, Pickering G, Ramilo I, Roman H, Canis M. Systematic review of endometriosis pain assessment: how to choose a scale? Hum Reprod Update. 2015;21(1):136–52. Fauconnier A, Chapron C, Dubuisson JB, Vieira M, Dousset B, Bréart G. Relation between pain symptoms and the anatomic location of deep infiltrating endometriosis. Fertil Steril. 2002;78(4):719–26. Follmann D, Wu M. An approximate generalized linear model with random effects for informative missing data. Int Biom Soc. 1995;5(1):151–68. Habib N, Centini G, Lazzeri L, Amoruso N, El Khoury L, Zupi E, et al. Bowel endometriosis: current perspectives on diagnosis and treatment. Int J Women’s Health. 2020;12:35–47. Milone M, Vignali A, Milone F, Pignata G, Elmore U, Musella M, et al. Colorectal resection in deep pelvic endometriosis: surgical technique and post-operative complications. World J Gastroenterol. 2015;21(47):13345–51. Roman H, group (FgFcIES). 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. J Gynecol Obstet Hum Reprod. 2017;46(2):159–65. Fedele L, Bianchi S, Zanconato G, Raffaelli R, Berlanda N. Is rectovaginal endometriosis a progressive disease? Am J Obstet Gynecol. 2004;191(5):1539–42. Abrao MS, Gonçalves MO, Dias JA, Podgaec S, Chamie LP, Blasbalg R. Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis. Hum Reprod. 2007;22(12):3092–7. Goncalves MO, Dias JA, Podgaec S, Averbach M, Abrão MS. Transvaginal ultrasound for diagnosis of deeply infiltrating endometriosis. Int J Gynaecol Obstet. 2009;104(2):156–60. Authors’ Contribution Statement Mauricio Simoes Abrao: study design, manuscript drafting, and critical discussion Marina Paula Andres: study design, execution, analysis, manuscript drafting, and critical discussion Mariana da Cunha Vieira: execution, analysis, and manuscript drafting Giuliano Moyses Borrelli: study design and critical discussion. João Siufi Neto: study design, manuscript drafting, and critical discussion. Code Availability Not applicable. Author information Authors and Affiliations Ethics declarations Conflict of Interest The authors declare that they have no conflicts of interest. Ethics Approval (Include Appropriate Approvals or Waivers) This study was approved by Institutional Review Board at Hospital das Clinicas under the number 1631417 (1.631.417 CAAE: 57077816.0.0000.0068). Consent to Participate Not applicable (the study was retrospective). Consent for Publication (Include Appropriate Statements) Not applicable (the study was retrospective). Ethical Consent All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Institutional Review Board at Hospital das Clinicas, São Paulo, BR, under the number 1631417; CAAE: 57077816.0.0000.0068) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Additional information Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The authors consider that Mauricio Simoes Abrao and Marina Paula Andres should be regarded as joint first authors Rights and permissions About this article Cite this article Abrao, M.S., Andres, M.P., da Cunha Vieira, M. et al. Clinical and Sonographic Progression of Bowel Endometriosis: 3-Year Follow-up. Reprod. Sci. 28, 675–682 (2021). https://doi.org/10.1007/s43032-020-00346-9 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s43032-020-00346-9