Diagnostic value of endoscopic ultrasonography in pelvic masses with bowel involvement

Yu Mo She, Ge N, Nan Ge
Therapeutic advances in gastroenterology · 2023 · vol. 16 , pp. 17562848231163414 · doi:10.1177/17562848231163414 · PMID:37153498 · PMC10161300 · W4372047241
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-28 ⓘ

This review examines the clinical value of endoscopic ultrasonography in accurately diagnosing benign and malignant pelvic masses and their intestinal involvement, aiding in preoperative evaluation and treatment selection.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-09 · read from full text ⓘ

This paper is a review summarizing evidence on diagnostic performance of endoscopic ultrasonography (EUS), including EUS-guided fine-needle aspiration (EUS-FNA) and EUS elastography, for pelvic masses with bowel involvement, with special attention to rectosigmoid disease in endometriosis. Across cited studies, EUS characterizes intestinal wall layers and typical colorectal endometriosis findings on imaging, reporting high diagnostic accuracy for rectal/sigmoid invasion in patients with known endometriosis, while also noting limitations such as reduced value for lesions distant from the probe and need for larger prospective studies for de novo cases; EUS-FNA accuracy is reported as variable and sometimes low in small samples. Relevance to endometriosis: the review specifically discusses EUS’s diagnostic value for rectosigmoid and rectal endometriosis infiltrating the intestinal wall (including pooled sensitivity/specificity and proposed imaging features) as part of its comparison among pelvic imaging modalities, and it frames EUS-FNA/elastography as adjuncts for colorectal endometriosis with bowel involvement. This paper is centrally about endometriosis — it reviews EUS for diagnosing rectosigmoid/rectal intestinal endometriosis with bowel involvement.

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Abstract

Benign and malignant pelvic masses with or without intestinal invasion are common in women of childbearing age. Patients may have nonspecific symptoms and signs or experience no symptoms. Laparoscopic resection of pelvic masses is currently the mainstream treatment; therefore, accurate preoperative evaluation is not only essential for patients suspected of having intestinal invasion, but also extremely important for the selection of follow-up treatment. Procedures, including endoscopic ultrasonography (EUS), pelvic magnetic resonance imaging, abdominal computed tomography, vaginal ultrasonography, barium enema, and colonoscopy, aid in determining the presence, depth, and histology of the disease. In particular, the wide application and continuous developments in EUS techniques have improved the diagnostic accuracy for intestinal subepithelial and peripheral organ lesions. This article reviewed the clinical value of EUS in the diagnosis of benign and malignant pelvic masses with bowel involvement.
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Intro

The intestinal tract is the most common extragenital invasive site of pelvic masses, such as endometriosis, affecting 3.8‒37% of patients with endometriosis, 1 and up to 95% of intestinal endometriosis is found in the rectum and sigmoid. The digestive system-related symptoms of pelvic masses infiltrating the rectosigmoid may include diarrhea, constipation, abdominal distension, and periodic rectal bleeding, which are similar to or overlap with the symptoms of irritable bowel syndrome, making the diagnosis of pelvic masses infiltrating the rectosigmoid challenging. 2 Intestinal invasion of pelvic masses is difficult to diagnose in up to 30‒40% of patients. This often leads to substantial treatment difficulties, including the delayed discovery of digestive system involvement, usually before or during surgery, which ultimately results in incomplete treatment. Since the late 1990s, endoscopic ultrasonography (EUS) has been used to preoperatively evaluate patients with endometriosis suspected of having rectosigmoid invasion. 3 , 4 The development of EUS has improved the potential for the preoperative diagnosis of benign and malignant pelvic masses. Numerous studies have proven its clinical value. Compared with other imaging techniques, EUS has better sensitivity for the diagnosis of benign pelvic diseases, close to 100%, and the positive and negative predictive values are as high as 86.8% and 97.7%, respectively. 5 – 7 Moreover, EUS is superior to pelvic magnetic resonance imaging (MRI) for the diagnosis of benign rectal and sigmoid pelvic masses. This review aimed to summarize the diagnostic value of EUS and compare it with other imaging methods for benign and malignant pelvic masses infiltrating the intestine.

Diagnostic

Kizaki et al. 45 reported a case of mature cystic teratoma of the ovary with rectum fistula caused by local inflammation. Because the patient had diarrhea symptoms, they carried out relevant endoscopy. They found that there were ulcerative lesions adjacent to the ovarian cyst in the rectal wall and suspected that ovarian teratoma formed a fistula to the rectum. Finally, laparoscopy confirmed this inference. Although the description of endoscopy in this study is relatively few, it shows the accuracy of EUS in the etiological diagnosis of ovarian mature teratoma with intestinal fistula. EUS is a promising and reliable minimally invasive imaging method for diagnosing benign and malignant pelvic tumors with digestive tract involvement. It has high diagnostic accuracy and cost-effectiveness. Most cases of pelvic masses of digestive tract infiltration are located at the distal end of the sigmoid, which is especially suitable for the application of EUS. It combines endoscopy and an ultrasound probe to evaluate the distal part of the rectum and sigmoid colon. Compared with other imaging examinations suitable for diagnosing pelvic masses and staging, EUS is easier to diagnose the intestinal and rectovaginal septal invasion of pelvic masses, while MRI and transvaginal ultrasound are more suitable for diagnosing ovarian lesions and bladder invasion. The diagnostic value of these imaging methods should be studied in prospective studies with a larger sample size to accurately determine which patients should benefit from EUS. For patients with pelvic masses who are worried about the rectosigmoid invasion, EUS, EUS-FNA, and EUS-E should be considered in addition to the diagnostic process of pelvic masses with intestinal invasion, and preoperative evaluation should be conducted through EUS and related technologies to help formulate the surgical plan, which can ensure that appropriate equipment and personnel are present to solve the most likely situation. In conclusion, MRI is the main examination method for comprehensive preoperative evaluation of benign and malignant pelvic masses. MRI combined with physical examination may be the main objective method for selecting the surgical approach and plan. The main function of EUS is to accurately evaluate the intestinal invasion of pelvic masses. The comprehensive application of various diagnostic methods for accurate preoperative evaluation can ensure complete resection of lesions, minimize the incidence of adverse events, and avoid the unreasonable use of medical resources.

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