Ultrasonography for bowel endometriosis

Simone Ferrero; Barra F; Fabio Barra; Carolina Scala; Scala C; G. Condous; George Condous; Condous G

doi:10.1016/j.bpobgyn.2020.05.010

Ultrasonography for bowel endometriosis

Simone Ferrero, Barra F, Fabio Barra, Carolina Scala, Scala C, G. Condous, George Condous, Condous G

Best practice & research. Clinical obstetrics & gynaecology · 2020 · vol. 71 , pp. 38–50 · doi:10.1016/j.bpobgyn.2020.05.010 · PMID:32620408 · W3033528906

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This paper reviews the utility of ultrasonography in diagnosing and characterizing bowel endometriosis, highlighting its role in preoperative assessment and surgical planning.

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Abstract

Transvaginal ultrasonography (TVS) should be the first-line investigation in patients with suspicion of deep endometriosis and, in particular, of rectosigmoid endometriosis. TVS cannot assess the presence of intestinal nodules located proximally to the sigmoid (such as ileal or cecal endometriotic nodules), because these lesions are beyond the field of the transvaginal probe. The ultrasonographic findings of rectosigmoid endometriosis are the presence of an irregular hypoechoic nodule in the anterior wall of the rectosigmoid colon. The learning curve for diagnosing rectosigmoid endometriosis by TVS is quite short; approximately, 40 scans are required to a sonographer who trained in general gynecologic ultrasonography to become proficient at diagnosing bowel endometriosis. Several meta-analyses confirmed the high diagnostic performance of TVS in diagnosing rectosigmoid endometriosis. The presence of "soft markers" (negative sliding sign and kissing ovaries) facilitates the diagnosis of rectosigmoid endometriosis. Enhanced TVS (rectal water-contrast transvaginal ultrasonography, sonovaginography, and tenderness-guided transvaginal ultrasonography) does not improve the performance of TVS in diagnosing rectosigmoid endometriosis. These investigations, however, may be useful to ascertain the depth of infiltration of endometriosis in the intestinal wall or the presence of rectal stenosis. Magnetic resonance imaging has the same performance of TVS in diagnosing rectosigmoid endometriosis; however, it should be recommended as a second-line technique in the preoperative workup of patients with previous equivocal TVS findings.

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Condition tags

endometriosisbowel_endometriosis

MeSH descriptors

Endometriosis Endometriosis Female Humans Magnetic Resonance Imaging Rectum Rectum Sensitivity and Specificity Ultrasonography

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[1] Accuracy of magnetic resonance imaging and rectal endoscopic sonography for the prediction of location of deep pelvic endometriosis via openalex

[2] Accuracy of rectal endoscopic ultrasonography and magnetic resonance imaging in the diagnosis of rectal involvement for patients presenting with deeply infiltrating endometriosis via openalex

[3] Accuracy of transvaginal sonography and contrast‐enhanced magnetic resonance‐colonography for the presurgical staging of deep infiltrating endometriosis via openalex

[4] Accuracy of transvaginal sonography and rectal endoscopic sonography in the diagnosis of deep infiltrating endometriosis via openalex

[5] Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in the rectosigmoid: systematic review and meta‐analysis via openalex

[6] Applying a statistical method in transvaginal ultrasound training: lessons from the learning curve cumulative summation test (LC-CUSUM) for endometriosis mapping via openalex

[7] A Prospective Study Comparing Three-Dimensional Rectal Water Contrast Transvaginal Ultrasonography and Computed Tomographic Colonography in the Diagnosis of Rectosigmoid Endometriosis via openalex

[8] Bidimensional rectal-water contrast-transvaginal ultrasonography (2D-RWC-TVS) versus 3D-RWC-TVS in the diagnosis of rectosigmoid endometriosis: a pilot prospective comparative study via openalex

[9] Bowel Endometriosis: Presentation, Diagnosis, and Treatment via openalex

[10] Can anyone screen for deep infiltrating endometriosis with transvaginal ultrasound? via openalex

[11] Can transvaginal sonography predict infiltration depth in patients with deep infiltrating endometriosis of the rectum? via openalex

[12] Comparison between transvaginal sonography, saline contrast sonovaginography and magnetic resonance imaging in the diagnosis of posterior deep infiltrating endometriosis via openalex

[13] Comparison of three-dimensional rectosonography, rectal endoscopic sonography and magnetic resonance imaging performances in the diagnosis of rectosigmoid endometriosis via openalex

[14] Comparison of transvaginal sonography and double‐contrast barium enema for diagnosing deep infiltrating endometriosis of the posterior compartment via openalex

[15] Computed Tomographic Colonography in the Diagnosis of Recto-Sigmoid Endometriosis: A Pilot Study via openalex

[16] Computed tomographic colonography <i>vs</i> rectal water‐ contrast transvaginal sonography in diagnosis of rectosigmoid endometriosis: a pilot study via openalex

[17] Correlation between three-dimensional rectosonography and magnetic resonance imaging in the diagnosis of rectosigmoid endometriosis: a preliminary study on the first fifty cases via openalex

[18] Deep Pelvic Endometriosis: MR Imaging for Diagnosis and Prediction of Extension of Disease via openalex

[19] Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis via openalex

[20] Diagnostic accuracy of sonovaginography for deep infiltrating endometriosis via openalex

[21] Diagnostic accuracy of transvaginal sonography for deep pelvic endometriosis via openalex

[22] Diagnostic accuracy of transvaginal ultrasound for non‐invasive diagnosis of bowel endometriosis: systematic review and meta‐analysis via openalex

[23] Diagnostic Performances of Tridimensional Rectosonography and Magnetic Resonance Imaging in Rectosigmoid Endometriosis: A Prospective Cohort Study on 101 Patients via openalex

[24] Diagnostic value of transvaginal 'tenderness-guided' ultrasonography for the prediction of location of deep endometriosis via openalex

[25] Does Bowel Preparation Improve the Performance of Rectal Water Contrast Transvaginal Ultrasonography in Diagnosing Rectosigmoid Endometriosis? via openalex

[26] Does transvaginal ultrasonography combined with water-contrast in the rectum aid in the diagnosis of rectovaginal endometriosis infiltrating the bowel? via openalex

[27] Double-Contrast Barium Enema and Transrectal Endoscopic Ultrasonography in the Diagnosis of Intestinal Deeply Infiltrating Endometriosis via openalex

[28] Double-contrast enema in pelvic endometriosis via openalex

[29] European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis via openalex

[30] How to Perform Ultrasonography in Endometriosis via openalex

[31] Imaging Modalities for Diagnosis of Deep Pelvic Endometriosis: Comparison between Trans-Vaginal Sonography, Rectal Endoscopy Sonography and Magnetic Resonance Imaging. A Head-to-Head Meta-Analysis via openalex

[32] Imaging modalities for the non-invasive diagnosis of endometriosis via openalex

[33] Initial Accuracy of and Learning Curve for Transvaginal Ultrasound with Bowel Preparation for Deep Endometriosis in a US Tertiary Care Center via openalex

[34] Interobserver agreement and accuracy of non‐invasive diagnosis of endometriosis by transvaginal sonography via openalex

[35] Interpreting the real-time dynamic ‘sliding sign’ and predicting pouch of Douglas obliteration: an interobserver, intraobserver, diagnostic-accuracy and learning-curve study via openalex

[36] “Kissing ovaries”: A sonographic sign of moderate to severe endometriosis via openalex

[37] Learning curve for ultrasonographic diagnosis of deep infiltrating endometriosis using structured offline training program via openalex

[38] Letrozole and norethisterone acetate in colorectal endometriosis via openalex

[39] Long-Term Administration of Dienogest for the Treatment of Pain and Intestinal Symptoms in Patients with Rectosigmoid Endometriosis via openalex

[40] Magnetic resonance enema <i>vs</i> rectal water‐contrast transvaginal sonography in diagnosis of rectosigmoid endometriosis via openalex

[41] Magnetic resonance imaging characteristics of deep endometriosis via openalex

[42] Modified Ultrasonographic Techniques via openalex

[43] Moose Antler Sign, a Sign of Deep Endometriosis Infiltrating Bowel via openalex

[44] Multidetector computerized tomography enteroclysis vs. rectal water contrast transvaginal ultrasonography in determining the presence and extent of bowel endometriosis via openalex

[45] Office gel sonovaginography for the prediction of posterior deep infiltrating endometriosis: a multicenter prospective observational study via openalex

[46] Preoperative assessment of intestinal endometriosis: a comparison of Transvaginal Sonography with Water-Contrast in the Rectum, Transrectal Sonography, and Barium Enema via openalex

[47] Preoperative Ultrasound Indications Determine Excision Technique for Bowel Surgery for Deep Infiltrating Endometriosis: A Single, High-Volume Center via openalex

[48] Preoperative work-up for patients with deeply infiltrating endometriosis: transvaginal ultrasonography must definitely be the first-line imaging examination via openalex

[49] Rectal Endoscopic Ultrasound with a Radial Probe in the Assessment of Rectovaginal Endometriosis via openalex

[50] Rectal water contrast transvaginal ultrasound versus double-contrast barium enema in the diagnosis of bowel endometriosis via openalex

[51] Sonovaginography is a new technique for assessing rectovaginal endometriosis via openalex

[52] Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group via openalex

[53] “Tenderness-guided” transvaginal ultrasonography: a new method for the detection of deep endometriosis in patients with chronic pelvic pain via openalex

[54] The prediction of pouch of Douglas obliteration using offline analysis of the transvaginal ultrasound 'sliding sign' technique: inter- and intra-observer reproducibility via openalex

[55] The Role of Computed Tomography Colonography in Detecting Bowel Involvement in Women With Deep Infiltrating Endometriosis via openalex

[56] The use of intra‐operative saline sonovaginography to define the rectovaginal septum in women with suspected rectovaginal endometriosis: a pilot study via openalex

[57] Three‐dimensional sonorectography: a new transvaginal ultrasound technique with intrarectal contrast to assess colorectal endometriosis via openalex

[58] Transvaginal sonography and rectal endoscopic sonography for the assessment of pelvic endometriosis: a preliminary comparison via openalex

[59] Transvaginal sonography for preoperative assessment of deep endometriosis via openalex

[60] Transvaginal sonography vs. clinical examination in the preoperative diagnosis of deep infiltrating endometriosis via openalex

[61] Transvaginal sonography with <i>vs</i> without bowel preparation in diagnosis of rectosigmoid endometriosis: prospective study via openalex

[62] Transvaginal ultrasonography combined with water-contrast in the rectum in the diagnosis of rectovaginal endometriosis infiltrating the bowel via openalex

[63] Transvaginal ultrasonography with bowel preparation is able to predict the number of lesions and rectosigmoid layers affected in cases of deep endometriosis, defining surgical strategy via openalex

[64] Transvaginal ultrasound after bowel preparation to assist surgical planning for bowel endometriosis resection via openalex

[65] Transvaginal ultrasound <i>vs</i> magnetic resonance imaging for diagnosing deep infiltrating endometriosis: systematic review and meta‐analysis via openalex

[66] Ultrasonographic soft markers for detection of rectosigmoid deep endometriosis via openalex

[67] Ultrasound mapping of pelvic endometriosis: does the location and number of lesions affect the diagnostic accuracy? a multicentre diagnostic accuracy study via openalex

[68] Ultrasound mapping system for the surgical management of deep infiltrating endometriosis via openalex

[69] Ureteral endometriosis: a systematic review of epidemiology, pathogenesis, diagnosis, treatment, risk of malignant transformation and fertility via openalex

[70] Uterine sliding sign: a simple sonographic predictor for presence of deep infiltrating endometriosis of the rectum via openalex

[71] Value of Endorectal Ultrasonography for Diagnosing Rectovaginal Septal Endometriosis Infiltrating the Rectum via openalex

[72] W2945004277 via openalex

[73] W2331185856 via openalex

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