Clinical and Sonographic Progression of Bowel Endometriosis: 3-Year Follow-up
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ENDOMETRIOSIS: ORIGINAL ARTICLE
Clinical and Sonographic Progression of Bowel Endometriosis: 3-Year Follow-up Mauricio Simoes Abrao 1,2 João Siufi Neto 2
&
Marina Paula Andres 1,2 & Mariana da Cunha Vieira 1,2 & Giuliano Moyses Borrelli 1 &
Received: 23 May 2020 / Accepted: 5 October 2020 # Society for Reproductive Investigation 2020
Abstract The aim of this study was to evaluate progression of the bowel endometriosis lesion over time. We performed a retrospective cohort with 164 patients with rectosigmoid endometriosis identified by transvaginal ultrasound (TVUS) with bowel preparation waiting for surgical treatment. Length and circumference of the bowel lesion evaluated by TVUS, painful symptoms (dysmenorrhea, dyspareunia, noncyclic pelvic pain, dyschezia, dysuria), and menopausal status were assessed at baseline and 6, 12, 24, 36, and > 36 months. A linear mixed model was used and p values < 0.05 were considered significant. We considered the length and the circumference as the main parameter; the characteristics were considered as fixed effects and the patient as random effect. This model allows to deal with missing data from longitudinal studies. All painful symptoms significantly improved during follow-up. Overall, the mean length and circumference of the greatest bowel lesion were 2.9 ± 1.8 cm and 27 ± 10%, respectively, and those did not change over time (p > 0.05). Patients with severe dyspareunia had significant greater circumference (p = 0.037) and those with severe dyschezia had significant greater length (p = 0.047) of bowel lesions. Symptoms were not related with progression of the lesion over time. The bowel lesion length significantly decreased over time in patients in menopause (p = 0.009). There was no difference in the bowel lesion length between patients with and without hormonal treatment (p > 0.05). The results suggest that bowel endometriosis does not increase over time during reproductive age and reduces after menopause. Symptoms are also not related to the bowel lesion progression. Keywords Bowel endometriosis . Disease progression . Hormonal treatment . Deep endometriosis . Transvaginal ultrasound
Introduction Bowel endometriosis is defined as the presence of endometriallike glands and/or stroma infiltrating at least the muscularis layer and affects 5 to 12% of women with deep endometriosis and the
rectosigmoid is involved in almost 90% of these cases. Endometriotic lesions in the rectosigmoid are characterized by hyperplasia and tissue fibrosis, starting from the serosa towards the bowel lumen, with consequent intestinal thickening and local constriction [1, 2]. The symptoms can vary from silent to
The authors consider that Mauricio Simoes Abrao and Marina Paula Andres should be regarded as joint first authors * Mauricio Simoes Abrao
Marina Paula Andres [email protected] Mariana da Cunha Vieira [email protected] Giuliano Moyses Borrelli [email protected]
João Siufi Neto [email protected] 1
Obstetrics and Gynecology Department. Hospital das Clinicas HCFMUSP, Faculdade
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