Lesion size and location in deep infiltrating bowel endometriosis: correlation with gastrointestinal dysfunction and pain

Daria Pashkunova, Ezgi Darıcı, Birgit Senft, Attila Bokor, Theresa Hudelist, Ayman Tammaa, Gernot Hudelist
In: Geburtshilfe und Frauenheilkunde · 2024 · vol. 84(09) , pp. e70–e71 · doi:10.1055/s-0044-1790156 · W4402921392
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-29 ⓘ

This study found no correlation between deep infiltrating bowel endometriosis lesion size or location and gastrointestinal dysfunction or pain, though involvement of other compartments significantly impacted dyspareunia.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-04 · read from full text ⓘ

This prospective study of 151 patients with histologically confirmed deep infiltrating bowel endometriosis evaluated whether colorectal lesion size (by #Enzian compartments C1/C2/C3) and lesion location (lesion-to-anal-verge distance, LAVD) correlated with preoperative gastrointestinal dysfunction using lower anterior resection syndrome–like (LARS) scores and with pain symptoms (numeric rating scale for dyschezia, dyspareunia, and dysmenorrhea). The study found no significant associations between either lesion size or LAVD and GI dysfunction or any measured pain outcomes, including when #Enzian C compartments were merged into severity grades. Concomitant involvement of #Enzian compartments A and/or B did not significantly change dyschezia or dysmenorrhea, showed only a non-significant trend for GI function, but was significantly associated with dyspareunia. This paper is centrally about endometriosis — specifically deep infiltrating bowel endometriosis in relation to lesion size/location, gastrointestinal dysfunction, and pain.

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Introduction

Deep infiltrating bowel endometriosis (DE) is associated with occurrence of dyschezia and gastrointestinal (GI) symptoms. The degree of the disease, the lesion length and the location, i.e. lesion-to-anal-verge distance (LAVD) of DE, as well as the severity of the symptoms appear to be correlated. The present study aims to evaluate a possible correlation of lesion location (LAVD) and size (according to the #Enzian classification) with preoperative symptoms.

Material and methods

In this prospective study, patients with histologically confirmed DE undergoing modified limited nerve-vessel sparing rectal segmental bowel resection (NVSSR) or full thickness discoid resection (FTDR) were evaluated. Extent of endometriosis was defined according to the #Enzian classification intraoperatively. The primary outcome measure was the correlation between lesion size and location with the GI function impairment reflected by presurgical lower anterior resection syndrome (LARS) scores; the secondary outcome were differences in presurgical numeric rating scale (NRS) pain scores of dyschezia, dyspareunia and dysmenorrhea as well as the impact of concomitant DE of other locations on symptom intensity.

Results

151 patients were included in the final analysis. No significant correlation was observed between lesion size (#Enzian compartments C1/C2/C3) or LAVD and GI dysfunction reflected by LARS-like symptoms (p=0.314 and p=0.185, respectively) or pain symptoms (dyschezia, p=0.440; dyspareunia, p=0.136 and dysmenorrhea p=0.221). Furthermore, no significant correlation was observed between lesion size and GI dysfunction when merging two severity grades (#Enzian compartments C1 plus C2 versus C3) (p=0.611). In addition, LAVD did not affect the degree of dyschezia (p=0.892), dyspareunia (p=0.395) or dysmenorrhea (p=0.705). Finally, the presence of concomitant DE lesions infiltrating the vagina/rectovaginal space (#Enzian compartment A) and/or sacrouterine ligaments/ parametrium (#Enzian compartment B) did not alter the severity of preoperative dyschezia (p=0.493) or dysmenorrhea (p=0.128) but showed a trend towards affecting GI function (p=0.078) and was significantly associated with dyspareunia (p=0.035).

Conclusion

In present study we could not find a correlation between colorectal DE lesion size and location (LAVD) and GI function impairment or pain symptoms intensity. Involvement of #Enzian compartment A and/or B exerts a significant impact on the degree of dyspareunia in women with colorectal DE. Publication History Article published online: 02 September 2024 © 2024. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

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Outcome instruments

NRS-pain Enzian

Condition tags

endometriosisbowel_endometriosis

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