[Comparison of endoscopic ultrasound and magnetic resonance imaging in severe pelvic endometriosis].
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Endoscopic ultrasound was more sensitive than MRI for diagnosing digestive endometriosis infiltration, while MRI better detected other pelvic lesions in women with severe endometriosis.
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Abstract
UNLABELLED: Deep pelvic endometriosis may lead to severe pain, the treatment of which may require complete surgical resection of lesions. Digestive infiltration is a difficult therapeutic problem. Preoperative diagnosis is difficult and digestive infiltration may remain unknown with incomplete resection and sometimes repeated surgery. Both magnetic resonance imaging (MRI) and endoscopic ultrasonography are able to detect rectosigmoid infiltration but their usefulness in the preoperative staging is still to be evaluated. The aim of this work was to evaluate and compare both techniques in the preoperative detection of deep pelvic endometriosis, particularly digestive infiltration. PATIENTS AND METHODS: From 1996 to 1998, 48 women with painful deep pelvic endometriosis had preoperative imaging exploration with endoscopic ultrasonography and MRI, and were operated on in order to attempt complete endometriosis resection. Patients were proposed for laparoscopic resection if endoscopic ultrasonography and/or MRI did not reveal digestive infiltration or for open resection if endoscopic ultrasonography and/or MRI were positive for digestive infiltration. RESULTS: Endoscopic ultrasonography and/or MRI led to suspicion of digestive endometriosis in 16 patients. Surgical resection was performed in 12 and digestive wall invasion was histologically demonstrated. At final follow-up, all patients had a dramatic decrease of their symptoms. The remaining 4 patients refused digestive resection and had only laparoscopic gynecologic resection. Infiltration although not histologically proven was very likely both on operative findings and clinical evolution. Digestive infiltration was preoperatively excluded in the 32 other patients. All had a laparoscopic treatment without digestive resection and pain diminished in all patients. In the 12 patients group who had digestive resection, digestive infiltration was correctly diagnosed by endoscopic ultrasonography in all cases (no false negative) whereas MRI, even with the use of endocoil antenna, led to correct diagnosis in 8 out of 12 cases. When endoscopic ultrasonography was negative for digestive infiltration, laparoscopic resection of lesions at surgery appeared complete in all cases. For the 16 patients with presumed digestive infiltration, sensitivity of endoscopic ultrasonography and MRI was 100 and 75% respectively, with a 100% specificity in both cases. MRI appeared very accurate for the detection of ovarian endometriotic locations. MRI was more sensitive but less specific than endoscopic ultrasonography for the diagnosis of isolated endometriotic recto-vaginal septum and utero-sacral ligaments lesions. CONCLUSION: Endoscopic ultrasonography was the best technique for the diagnosis of digestive endometriotic infiltration, which complicates the therapeutic strategy. MRI, however, allows more complete staging of other pelvic endometriotic lesions.
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- Is training sufficient for ultrasound operators to diagnose deep infiltrating endometriosis and bowel involvement by transvaginal ultrasound? 2018
- Imaging modalities for the non-invasive diagnosis of endometriosis 2016
- Correlation of the three-dimensional ultrasound findings with pathology in patients with deep pelvic infiltrating endometriosis submitted to surgery 2016
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- Valor do enema de bário com duplo contraste no diagnóstico da endometriose do reto e sigmóide 2008
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- Apport de l'échoendoscopie rectale au bilan d'extension de l'endométriose profonde. Diagnostic positif et topographie des atteintes digestives 2007
- Endorectal Ultrasonography in Predicting Rectal Wall Infiltration in Patients With Deep Pelvic Endometriosis: A Modern Tool for an Ancient Disease 2006
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- Prevalence and distribution of adnexal findings suggesting endometriosis in patients with MR diagnosis of adenomyosis 2006
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- Symptoms before and after surgical removal of colorectal endometriosis that are assessed by magnetic resonance imaging and rectal endoscopic sonography 2004
- Prise en charge chirurgicale des endométrioses de la cloison rectovaginale. À propos d’une série continue de 50 cas 2004
- Diagnostic accuracy of transvaginal sonography for deep pelvic endometriosis 2004
- Deep Pelvic Endometriosis: MR Imaging for Diagnosis and Prediction of Extension of Disease 2004
- Laparoscopic excision of deep endometriosis 2004
- L’endométriose pelvienne profonde : prise en charge thérapeutique et proposition d’une « classification chirurgicale » 2003
- Transvaginal sonography and rectal endoscopic sonography for the assessment of pelvic endometriosis: a preliminary comparison 2003
- Prise en charge chirurgicale des nodules endométriosiques de la cloison recto-vaginale. A propos d'une série continue de 40 cas 2002
- Endométriose rectosigmoïdlenne, généralités, description clinique et signes échoendoscopiques 2002
- Endométriose colorectale. Diagnostic et prise en charge 2001
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