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Clinical and Sonographic Progression of Bowel Endometriosis: 3-Year Follow-up

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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.

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Authors’ Contribution Statement

Mauricio Simoes Abrao: study design, manuscript drafting, and critical discussion

Marina Paula Andres: study design, execution, analysis, manuscript drafting, and critical discussion

Mariana da Cunha Vieira: execution, analysis, and manuscript drafting

Giuliano Moyses Borrelli: study design and critical discussion.

João Siufi Neto: study design, manuscript drafting, and critical discussion.

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Authors and Affiliations

  1. Obstetrics and Gynecology Department. Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 10° andar. Cerqueira Cesar, São Paulo, SP, 05403-000, Brazil

    Mauricio Simoes Abrao, Marina Paula Andres, Mariana da Cunha Vieira & Giuliano Moyses Borrelli

  2. Gynecologic Division, BP - Beneficencia Portuguesa de Sao Paulo, Rua Maestro Cardim, 769, Bela Vista, São Paulo, SP, 01323-001, Brazil

    Mauricio Simoes Abrao, Marina Paula Andres, Mariana da Cunha Vieira & João Siufi Neto

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  1. Mauricio Simoes Abrao
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Conflict of Interest

The authors declare that they have no conflicts of interest.

Ethics Approval (Include Appropriate Approvals or Waivers)

This study was approved by Institutional Review Board at Hospital das Clinicas under the number 1631417 (1.631.417 CAAE: 57077816.0.0000.0068).

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Not applicable (the study was retrospective).

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Not applicable (the study was retrospective).

Ethical Consent

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Institutional Review Board at Hospital das Clinicas, São Paulo, BR, under the number 1631417; CAAE: 57077816.0.0000.0068) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The authors consider that Mauricio Simoes Abrao and Marina Paula Andres should be regarded as joint first authors

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Abrao, M.S., Andres, M.P., da Cunha Vieira, M. et al. Clinical and Sonographic Progression of Bowel Endometriosis: 3-Year Follow-up. Reprod. Sci. 28, 675–682 (2021). https://doi.org/10.1007/s43032-020-00346-9

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  • DOI: https://doi.org/10.1007/s43032-020-00346-9

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