OP14.07: Expectant management of deep pelvic endometriosis (DE): an ultrasound study

To examine the natural history of DE in women that are managed expectantly. This was a retrospective cohort study of 87 women with evidence of DE, who were managed expectantly for a minimum of 6 months. All women attended for a minimum of two ultrasound scans by a single expert ultrasound operator. The mean diameter of endometriotic nodules was calculated from measurements in three orthogonal planes. Nodule growth rate was expressed as annual change in the mean diameter. During the study period, 1411 women were found to have moderate or severe endometriosis on pelvic ultrasound examination. 267 women had at least two scans by a single operator, a minimum of 6 months apart. 100 women were managed expectantly, of which 87% had evidence of DE and were included in the final analysis. The median follow up was 666 days (181–2984). In 28/87 (32%, 95% CI 22 - 42) women, new nodules were recorded. 5/79 (6%, 95% CI 1 -11) women had spontaneous resolution of nodules. However, no women had complete resolution of all endometriotic nodules. 21/87 (24%) women experienced an overall reduction in nodule size, 27/87 (31%) experienced no meaningful difference and 39/87 (45%) experienced an increase in nodule size. 3/25 (12%) women developed new evidence of bowel involvement. No women developed new evidence of bladder involvement. The median change in diameter of nodules during the study period was +0.33mm (-28.67 to +19.00), with an annual growth rate of +0.16 mm/year (-7.73 to +20.03). Many women with moderate or severe endometriosis can be managed expectantly. The behaviour of deep pelvic endometriosis is variable and in the majority of women there is no evidence of progression over time. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.