PROSPECTIVE EVALUATION OF CONTRAST-ENHANCED ENDOSCOPIC ULTRASOUND AND ELASTOGRAPHY FOR DEEP PELVIC ENDOMETRIOSIS WITH BOWEL INVOLVEMENT

C. Fortier Beaulieu, Madleen Chassang, Marion Le Maréchal, Cécile Gomercic, Marc Barthet, T. Piche, J. Delotte, G. Vanbiervliet
In: Endoscopy · 2019 · doi:10.1055/s-0039-1681223 · W2946566578
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This study evaluated the diagnostic value of contrast-enhanced endoscopic ultrasound and elastography for characterizing bowel lesions in deep pelvic endometriosis.

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This prospective study evaluated the utility of contrast-enhanced endoscopic ultrasound and elastography in characterizing bowel lesions associated with deep pelvic endometriosis. Researchers assessed thirty-three women who had previously identified bowel involvement via magnetic resonance imaging, analyzing forty-one nodules for enhancement patterns and tissue stiffness. The findings indicated that iso- or hyper-enhancement combined with high elastographic ratios predicted active disease and a favorable symptomatic response to hormonal therapy. This paper is centrally about endometriosis — specifically the diagnostic characterization of deep infiltrating endometriosis with bowel involvement using advanced endoscopic ultrasound techniques.

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Abstract

Rectal endoscopic ultrasonography completes the iconographic assessment of Deep Pelvic Endometriosis (DPE) with a diagnostic sensitivity of 90% for bowel involvement. No study has evaluated the value of endoscopic ultrasound with elastography and contrast enhancement (CE-EUS) to characterize bowel lesions in DPE. The aim of this study was to characterize the bowel involvement of DPE by elastography and CE-EUS.
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Methods

This was a prospective, non-comparative, monocentric study evaluating a single group of patients, conducted from April 2015 to January 2018 at Nice University Hospital (ClinicalTrial.gov NCT03138954). Women with deep pelvic endometriosis and bowel involvement suggested beforehand by Magnetic Resonance Imaging were included. Each patient benefited from standard rectal EUS under sedation with a series of elastographic measurements and evaluation of CE-EUS (Sonovue) on bowel endometriosis's nodules.

Results

Thirty-three patients (mean age 34.4 years [24 – 45]) with 41 bowel nodules of endometriosis were included. On the 33 nodules selected to perform the different analyses, 32 (97%) had significant contrast-enhancement. Eleven presented a hyper-enhancement (34.4%), nine an iso-enhancement (28.1%) and 12 a hypo-enhancement (37.5%). The mean elastography of the nodules, expressed as a ratio without unit, was 9.3 ± 5.2 [3.74 – 23.86]. The presence of an iso or hyper-enhancement associated with a high elastographic ratio was associated with active lesions and a better therapeutic response. Of the 11 patients with these ultrasound characteristics, 9 responded favorably symptomatically after the introduction of a hormonal treatment brake. The 2 patients who had no clinical improvement had not benefited from a specific care.

Conclusions

EUS with elastography and CE-EUS during DPE assessment is safe and improves the characterization of bowel lesions of endometriosis. The description of active lesions (iso- or hyper-enhancement, high ratio of elastometry) could be predictive of a better response to medical treatment.

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endometriosis

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