The Association Between Gastrointestinal Symptoms and Transvaginal Ultrasound Findings in Women Referred for Endometriosis Evaluation: A Prospective Pilot Study

Purpose To evaluate the relationship between gastrointestinal (GI) symptoms and transvaginal ultrasound (TVUS) findings suggestive of endometriosis.

A prospective design. Women referred for a diagnostic ultrasound due to suspicion of endometriosis completed a Rome III and Pelvic Floor Distress Inventory (PFDI-20) questionnaire for clinical, GI symptoms, before undergoing TVUS. Endometriosis was diagnosed in the presence of endometriomas and/or deeply infiltrative endometriotic (DIE) lesions. Association between lesion sites and GI symptoms was evaluated by univariate and multivariate analysis.

The study included 241 women who presented with: dysmenorrhea (89.6 %), dyspareunia (76.3 %), chronic pelvic pain (77.2 %), dyschezia (66 %), hematochezia (15.4 %), subfertility (24.5 %). GI symptoms were present in 25.3–76.8 % and 5.4–55.6 % of Rome III and PFDI-20 questionnaire responses, respectively. TVUS findings were endometriomas (23.2 %), peritoneal adhesions (46.5 %), uterosacral ligament (26.7 %), retrocervical (11.2 %), rectosigmoid (11.2 %), intestinal (4.6 %), and bladder (0.8 %) involvement, and pouch of Douglas (POD) obliteration (15.4 %). There was a high prevalence of peritoneal adhesions, uterosacral ligament involvement, and rectosigmoid and intestinal nodules on TVUS in women with GI symptoms, up to Chi2 = 9.639 (p = 0.013) on univariate and Chi2 = 8.102 (p = 0.005) on multivariate analysis.

We observed an almost 10-fold increase in DIE lesions in women with GI symptoms. We suggest that the presence of GI symptoms should prompt a referral for endometriosis evaluation and performance of a dedicated TVUS before invasive gastrointestinal procedures. Zusammenfassung Ziel Bewertung des Zusammenhangs zwischen gastrointestinalen (GI) Symptomen und den Befunden im transvaginalen Ultraschall (TVUS) bei Verdacht auf Endometriose.

und Methoden Ein prospektives Design. Frauen, die wegen Verdacht auf Endometriose zur Ultraschalldiagnostik überwiesen wurden, beantworteten vor dem TVUS einen Rom-III- und einen Pelvic-Floor-Distress-Inventory-20 (PFDI-20)-Fragebogen bezüglich klinischer GI-Symptome. Die Endometriose wurde bei Vorliegen von Endometriomen und/oder tief infiltrierenden endometriotischen (DIE) Läsionen diagnostiziert. Der Zusammenhang zwischen Läsionsstellen und GI-Symptomen wurde durch univariate und multivariate Analysen ausgewertet. Ergebnisse Die Studie umfasste 241 Frauen mit Dysmenorrhoe (89,6 %), Dyspareunie (76,3 %), chronischen Beckenschmerzen (77,2 %), Dyschezia (66 %), Hämatochezie (15,4 %) und Subfertilität (24,5 %). Bei 25,3–76,8 % der Antworten auf dem Rom-III-Fragebogen und 5,4–55,6 % der Antworten auf dem PFDI-20-Fragebogen lagen GI-Symptome vor. TVUS-Befunde waren Endometriome (23,2 %), peritoneale Adhäsionen (46,5 %), Beteiligung von Ligamentum sacrouterinum (26,7 %), retrozervikale (11,2 %) und rektosigmoidale (11,2 %) Beteiligung, Darm- (4,6 %) und Blasenbeteiligung (0,8 %) sowie Douglas-Obliteration (POD) (15,4 %). Bei Frauen mit GI-Symptomen war eine hohe Prävalenz von peritonealen Adhäsionen, Beteiligung des Lig. sacrouterinum sowie rektosigmoidalen und intestinalen Knötchen zu beobachten, mit Chi2 = 9,639 (p = 0,013) bei univariater und Chi2 = 8,102 (p = 0,005) bei multivariater Analyse. Schlussfolgerung Bei Frauen mit GI-Symptomen beobachteten wir eine fast 10-fache Zunahme der DIE-Läsionen. Wir schlagen vor, dass vor invasiven gastrointestinalen Eingriffen bei Vorliegen von GI-Symptomen eine Überweisung zur Endometriose-Diagnostik und einem entsprechenden TVUS erfolgen sollte. Key words endometriosis - ROME 3 - noninvasive imaging - gastrointestinal symptoms - transvaginal ultrasoundPublication History Received: 20 May 2020 Accepted: 20 October 2020 Article published online: 14 December 2020 © 2020. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany -

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