The value of pre-operative outpatient flexible sigmoidoscopy in patients with deep infiltrating endometriosis

T Sewell, Sewell T, Orchard M, M Orchard, O O'donovan, Oliver O'Donovan, O'Donovan O, Longman RJ, Randy Longman, R J Longman
Facts, views & vision in ObGyn · 2023 · vol. 15(2) , pp. 123–129 · doi:10.52054/fvvo.15.2.076 · PMID:37436048 · PMC10410654 · W4383683495
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-07 ⓘ

This study analyzed 102 patients with deep infiltrating endometriosis and found no intraluminal disease, suggesting routine flexible sigmoidoscopy offers limited diagnostic benefit for this condition.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text ⓘ

This retrospective case series evaluated whether pre-operative outpatient flexible sigmoidoscopy helps in diagnosing and planning management for suspected rectovaginal deep infiltrating endometriosis, using 102 consecutive patients referred for sigmoidoscopy between 2010 and 2020 under a specialist multidisciplinary endometriosis team. No cases were found to confirm intraluminal (luminal) disease on sigmoidoscopy, while non-specific bowel findings such as tight angulation were present in 36.3%; after sigmoidoscopy, 100 proceeded to surgery and the risk of bowel resection during surgery was 4%. The authors conclude that routine sigmoidoscopy offers limited benefit due to the low incidence of luminal disease, and recommend selective use when serious colorectal pathology is considered or to help locate lesions for surgical planning. This paper is centrally about endometriosis — it specifically assesses the diagnostic and pre-surgical utility of flexible sigmoidoscopy in rectovaginal deep infiltrating endometriosis.

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Abstract

BACKGROUND: Deep infiltrating endometriosis (DE) is a particularly severe disease which affects 10-20% of women with endometriosis. 90% of DE is rectovaginal and when suspected, some clinicians have suggested the routine use of flexible sigmoidoscopy to identify intraluminal disease. We aimed to assess the value of sigmoidoscopy prior to surgery for rectovaginal DE, both in terms of diagnosis and planning management. OBJECTIVES: We aimed to assess the value of sigmoidoscopy prior to surgery for rectovaginal DE. MATERIALS AND METHODS: A retrospective case series study was performed from a consecutive cohort of patients with DE referred for outpatient flexible sigmoidoscopy between January 2010 and January 2020. All patients were under the care of a specialist endometriosis multidisciplinary team. MAIN OUTCOME MEASURES: The primary outcome measure was the incidence of luminal disease. RESULTS: 102 consecutive cases were analysed with no cases confirming intraluminal disease. Non-specific evidence of endometriosis such as tight angulation of the bowel was found in 36.3%. Following sigmoidoscopy 100 patients proceeded to surgery and the risk of bowel resection during surgery was 4%. CONCLUSIONS: Due to the low incidence of luminal endometriosis, performing sigmoidoscopy routinely is of limited benefit. We recommend the selective use of sigmoidoscopy where serious pathology such as colorectal neoplasia is considered or to determine the location of endometriosis lesions which aids subsequent resectional surgery planning. WHAT IS NEW?: This large case series details a very low incidence of intraluminal disease and makes recommendations for the specific scenarios where flexible sigmoidoscopy should be used.
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Abstract

Background Deep infiltrating endometriosis (DE) is a particularly severe disease which affects 10-20% of women with endometriosis. 90% of DE is rectovaginal and when suspected, some clinicians have suggested the routine use of flexible sigmoidoscopy to identify intraluminal disease. We aimed to assess the value of sigmoidoscopy prior to surgery for rectovaginal DE, both in terms of diagnosis and planning management.

Objectives

We aimed to assess the value of sigmoidoscopy prior to surgery for rectovaginal DE.

Materials and methods

A retrospective case series study was performed from a consecutive cohort of patients with DE referred for outpatient flexible sigmoidoscopy between January 2010 and January 2020. All patients were under the care of a specialist endometriosis multidisciplinary team. Main outcome measures The primary outcome measure was the incidence of luminal disease.

Results

102 consecutive cases were analysed with no cases confirming intraluminal disease. Non-specific evidence of endometriosis such as tight angulation of the bowel was found in 36.3%. Following sigmoidoscopy 100 patients proceeded to surgery and the risk of bowel resection during surgery was 4%.

Conclusions

Due to the low incidence of luminal endometriosis, performing sigmoidoscopy routinely is of limited benefit. We recommend the selective use of sigmoidoscopy where serious pathology such as colorectal neoplasia is considered or to determine the location of endometriosis lesions which aids subsequent resectional surgery planning. What is new? This large case series details a very low incidence of intraluminal disease and makes recommendations for the specific scenarios where flexible sigmoidoscopy should be used.

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Condition tags

endometriosisdie_deep_infiltrating

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