Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 28, 2015; 21(16): 4997-5001
Published online Apr 28, 2015. doi: 10.3748/wjg.v21.i16.4997
Role of colonoscopy in the diagnostic work-up of bowel endometriosis
Marco Milone, Antonio Mollo, Mario Musella, Paola Maietta, Loredana Maria Sosa Fernandez, Olena Shatalova, Alessandro Conforti, Gianni Barone, Giuseppe De Placido, Francesco Milone
Marco Milone, Mario Musella, Paola Maietta, Olena Shatalova, Gianni Barone, Francesco Milone, Department of Advanced Biomedical Science, University of Naples “Federico II”, 80131 Naples, Italy
Antonio Mollo, Loredana Maria Sosa Fernandez, Giuseppe De Placido, Department of Neuroscience, Reproductive Science and Odonstostomatology, University of Naples “Federico II”, 80131 Naples, Italy
Gianni Barone, Department of Surgery, Fatebenefratelli Hospital, 80123 Naples, Italy
Author contributions: Milone M and Musella M contributed equally to this manuscript; Milone M was the main investigator and wrote the first manuscript draft; Milone M, Mollo A, Musella M, Maietta P, Sosa Fernandez LM, Shatalova O, Conforti A and Barone G designed the study; Maietta P, Sosa Fernandez LM, Shatalova O, Conforti A and Barone G were involved in patient recruitment and collection of the data; Milone M, Mollo A, Musella M and Barone G significantly contributed to the interpretation of findings; Milone F and De Placido G share the co-seniorship, approved the research and significantly contributed to the final version of the article; all the authors read and approved the final manuscript.
Ethics approval: The study was reviewed and approved by the Local Ethics Committee of the University of Naples “Federico II”.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: The authors have no conflicting interest to declare.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Marco Milone, MD, Department of Advanced Biomedical Science, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy. milone.marco@alice.it
Telephone: +82-39-817463064 Fax: +82-39-817462896
Received: October 15, 2014
Peer-review started: October 15, 2014
First decision: December 2, 2014
Revised: December 20, 2014
Accepted: February 12, 2015
Article in press: February 13, 2015
Published online: April 28, 2015

AIM: To evaluate the accuracy of colonoscopy for the prediction of intestinal involvement in deep pelvic endometriosis.

METHODS: This prospective observational study was performed between September 2011 and July 2014. Only women with both a clinical and imaging diagnosis of deep pelvic endometriosis were included. The study was approved by the local ethics committee and written informed consent was obtained in all cases. Both colonoscopy and laparoscopy were performed by expert surgeons with a high level of expertise with these techniques. Laparoscopy was performed within 4 wk of colonoscopic examination. All hypothetical colonoscopy findings (eccentric wall thickening with or without surface nodularities and polypoid lesions with or without surface nodularities of endometriosis) were compared with laparoscopic and histological findings. We calculated the sensitivity, specificity, positive predictive value and negative predictive value for the presence of colonoscopic findings of intestinal endometriosis.

RESULTS: A total of 174 consecutive women aged between 21-42 years with a diagnosis of deep pelvic endometriosis who underwent colonoscopy and surgical intervention were included in our analysis. In 76 of the women (43.6%), intestinal endometrial implants were found at surgery and histopathological examination. Specifically, 38 of the 76 lesions (50%) were characterized by the presence of serosal bowel nodules; 28 of the 76 lesions (36.8%) reached the muscularis layer; 8 of the 76 lesions (10.5%) reached the submucosa; and 2 of the 76 lesions (2.6%) reached the mucosa. Colonoscopic findings suggestive of intestinal endometriosis were detected in 7 of the 174 (4%) examinations. Colonoscopy failed to diagnose intestinal endometriosis in 70 of the 76 women (92.1%). A colonoscopic diagnosis of endometriosis was obtained in all cases of mucosal involvement, in 3 of 8 cases (37.5%) of submucosal involvement, in no cases of muscularis layer involvement and in 1 of 38 cases (2.6%) of serosa involvement. The sensitivity, specificity, positive predictive and negative predictive values of colonoscopy for the diagnosis of intestinal endometriosis were 7%, 98%, 85% and 58%, respectively.

CONCLUSION: Being an invasive procedure, colonoscopy should not be routinely performed in the diagnostic work-up of bowel endometriosis.

Keywords: Endometriosis, Colonoscopy, Intestinal, Bowel, Laparoscopy

Core tip: Endometriosis is common gynecological condition that in a substantial number of cases injures intestinal tissue and causes remarkable morbidity among affected individuals. A surgical approach is still the most effective, but preoperative assessment is often challenging even for expert physicians and requires several diagnostic techniques for a clear definition of the location and extent of endometrial implants. The aim of the present study was to evaluate the role of colonoscopy in the diagnostic work-up of bowel endometriosis.