Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2019; 25(6): 696-706
Published online Feb 14, 2019. doi: 10.3748/wjg.v25.i6.696
Preoperative rectosigmoid endoscopic ultrasonography predicts the need for bowel resection in endometriosis
Victor Desplats, René-Louis Vitte, Joseph du Cheyron, Gilles Roseau, Arnaud Fauconnier, Frédérick Moryoussef
Victor Desplats, René-Louis Vitte, Frédérick Moryoussef, Department of Hepato-gastro-enterology, Centre Hospitalier Intercommunal Poissy Saint Germain, Poissy 78300, France
Joseph du Cheyron, Department of Statistics, Centre Hospitalier Intercommunal Poissy Saint Germain, Poissy 78300, France
Gilles Roseau, Department of Gastroenterology, Hôpital Cochin, Paris 75014, France
Arnaud Fauconnier, Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal Poissy Saint Germain, University of Saint Quentin en Yvelines, Poissy 78300, France
Author contributions: Desplats V designed, performed the research and wrote the paper; du Cheyron J contributed to the analysis; Vitte RL, Roseau G and Fauconnier A provided clinical advice; Moryoussef F designed the research and supervised the report.
Institutional review board statement: The cohort used for this study had the approval of the local ethic committee of Centre Hospitalier Intercommunal Poissy Saint Germain.
Informed consent statement: All patients included in this retrospective analysis gave their prior informed consent for inclusion in the cohort.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: 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/
Corresponding author: Victor Desplats, MD, Doctor, Medical Resident, Department of Hepato-gastro-enterology, Centre Hospitalier Intercommunal Poissy Saint Germain, 10 rue du Champ Gaillard, Poissy 78300, France. victor.desplats@aphp.fr
Telephone: +33-663185173
Received: December 7, 2018
Peer-review started: December 8, 2018
First decision: December 28, 2018
Revised: January 14, 2018
Accepted: January 18, 2019
Article in press: January 18, 2019
Published online: February 14, 2019
Abstract
BACKGROUND

Rectosigmoid endometriosis is an underdiagnosed disease responsible for abdominal pain, transit disorders and rectal bleeding. Two surgical approaches, rectosigmoid bowel resection (segmental or patch) or intramuscular layer dissection (shaving), are available.

AIM

To assess whether the lesion features observed via preoperative rectosigmoid endoscopic ultrasonography (RS-EUS) might predict the need for bowel resection.

METHODS

This multicentric retrospective study was conducted on patients with rectosigmoid endometriosis who underwent a curative surgical procedure, evaluated by RS-EUS performed by two trained operators, between January 2012 and March 2018. A univariate statistical analysis was performed on nodules’ RS-EUS features (thickness, width, infiltration of the submucosae, presence of a bump into the digestive lumen and presence of multiple rectosigmoid localizations). A multivariate logistic regression was then performed on the significant results.

RESULTS

Of the 367 patients, 73 patients with rectosigmoid endometriosis were evaluated by RS-EUS and underwent rectosigmoid surgery. After the univariate analysis was completed, thickness, width and infiltration of the submucosae were identified as potential predictive factors for bowel resection. In a multivariate logistic regression model, only thickness appeared to be a significant [odds ratio (OR) = 1.49, 95% confidence interval (CI): 1.04-2.12, P = 0.028] predictive factor for bowel resection. Receiver operating characteristic analysis performed showed that a thickness over 5.20 mm might be used as cut-off with a sensitivity of 76%, a specificity of 81%, and an area under carve = 0.82. The cut-off values for 100% sensitivity and 100% specificity were 0.90 mm and 10.00 mm, respectively. A trend concerning width to predict the need for resection was also observed (OR 1.12, 95%CI: 1.00-1.26, P = 0.054)

CONCLUSION

The presence of a rectosigmoid nodule of endometriosis greater than 5.20 mm thick on RS-EUS might predict the need for bowel resection.

Keywords: Endometriosis, Surgery, Endoscopy, Ultrasound, Bowel disease, Rectum and sigmoid

Core tip: Rectosigmoid endometriosis is an underdiagnosed disease responsible for abdominal pain, transit disorders and rectal bleeding. The treatment can be either medical or surgical. If a surgical resection of the bowel is needed, it must be performed by a multidisciplinary team. The aim of our study was to assess whether the lesion features observed via preoperative rectosigmoid endoscopic ultrasonography (RS-EUS), a key exam in this condition, might predict the need for bowel resection. We found that the presence of a rectosigmoid nodule of endometriosis greater than 5.20 mm thick on RS-EUS might predict the need for bowel resection.