The Diagnosis and Management of Severe Endometriosis

Mallick, Rebecca

doi:10.15406/mojs.2017.04.00087

Cited by 1 publication

(1 citation statement)

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“…Surgery has traditionally been seen as the mainstay of treatment ( Hoo et al, 2017 ) and despite some evidence showing good results from medical therapy alone ( Wild et al, 2019 ), surgery will be indicated for many women. Surgery for rectovaginal DE aims to completely excise all visible endometriosis and is reported to have good long-term outcomes with significant improvements in symptoms and quality of life ( Mallick, 2017 ; Byrne et al, 2018 ). Due to the complexity of surgery and the risk of significant morbidity associated with the potential for bowel resection and possible stoma formation, thorough pre-operative investigation and a comprehensive consent process is indicated.…”

Section: Discussionmentioning

confidence: 99%

The value of pre-operative outpatient flexible sigmoidoscopy in patients with deep infiltrating endometriosis

Sewell¹,

Orchard²,

O'Donovan³

et al. 2023

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Background: Deep infiltrating endometriosis (DE) is a particularly severe disease which affects 10-20% of women with endometriosis. 90% of DE is rectovaginal and when suspected, some clinicians have suggested the routine use of flexible sigmoidoscopy to identify intraluminal disease. We aimed to assess the value of sigmoidoscopy prior to surgery for rectovaginal DE, both in terms of diagnosis and planning management. Objectives: We aimed to assess the value of sigmoidoscopy prior to surgery for rectovaginal DE. Materials and Methods: A retrospective case series study was performed from a consecutive cohort of patients with DE referred for outpatient flexible sigmoidoscopy between January 2010 and January 2020. All patients were under the care of a specialist endometriosis multidisciplinary team. Main outcome measures: The primary outcome measure was the incidence of luminal disease. Results: 102 consecutive cases were analysed with no cases confirming intraluminal disease. Non-specific evidence of endometriosis such as tight angulation of the bowel was found in 36.3%. Following sigmoidoscopy 100 patients proceeded to surgery and the risk of bowel resection during surgery was 4%. Conclusions: Due to the low incidence of luminal endometriosis, performing sigmoidoscopy routinely is of limited benefit. We recommend the selective use of sigmoidoscopy where serious pathology such as colorectal neoplasia is considered or to determine the location of endometriosis lesions which aids subsequent resectional surgery planning. What is new? This large case series details a very low incidence of intraluminal disease and makes recommendations for the specific scenarios where flexible sigmoidoscopy should be used.

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