Transvaginal Ultrasound with bowel preparation alone might be best method for diagnosing rectosigmoid endometriosis: Study

Recent paper provided a comprehensive overview and comparison of the diagnostic approaches for rectosigmoid endometriosis, emphasized the clinical importance of accurate diagnosis, and discussed the practical implications of the findings in a clinical context.

The research paper conducted a systematic review and meta-analysis to compare the diagnostic performance of transvaginal ultrasound with bowel preparation alone and with bowel preparation plus rectal water contrast in detecting rectosigmoid endometriosis. The meta-analysis included nine studies published between 2000 and 2023, and the mean prevalence of endometriosis rectosigmoid was 43.6% for the group with bowel preparation and 64.8% for the group with bowel preparation and rectal water contrast. The pooled sensitivity and specificity were reported as 93% and 94% for bowel preparation alone and 92% and 95% for bowel preparation with water contrast.

Clinical Importance of Diagnosing Rectosigmoid Endometriosis

Overall, the findings suggested that there was no significant difference in the diagnostic performance between transvaginal ultrasound with bowel preparation alone and with rectal water contrast. It was emphasized that the absence of a significant difference between these methods should be considered in clinical practice when making recommendations. The paper highlighted the clinical importance of accurately diagnosing rectosigmoid endometriosis, which affects up to 10% of women of reproductive age and can have a significant impact on quality of life.

The study discussed the challenges of diagnosing deep pelvic endometriosis, particularly the rectosigmoid involvement, and highlighted transvaginal ultrasound as a valuable imaging tool for its assessment. The paper elaborated on the technical details of the included studies, the diagnostic criteria used, and the potential biases in patient selection and timing of evaluations, providing a comprehensive assessment of the methodological quality of the studies included in the meta-analysis.

Clinical Implications of the Study Findings

The authors discussed the clinical implications of their findings, suggesting that transvaginal ultrasound with bowel preparation alone might be the best method for diagnosing rectosigmoid endometriosis, considering the invasiveness of the method with rectal water contrast. They emphasized the need for better quality studies using uniform definition criteria in a larger series of patients to validate the preliminary results. The paper also highlighted potential drawbacks associated with transvaginal ultrasound using rectal water contrast, such as prolonged examination times, patient discomfort, and financial implications, further supporting the recommendation for ultrasound with bowel preparation alone as the preferred diagnostic approach for rectosigmoid endometriosis.

Conclusion

In conclusion, the research paper not only provided a detailed overview of the meta-analysis comparing the two diagnostic approaches but also discussed the practical implications of the findings in a clinical context, highlighting the need for further research to validate the results and optimize the diagnosis of endometriosis rectosigmoid.

Key Points

- The paper emphasized the clinical importance of accurately diagnosing rectosigmoid endometriosis, which can affect up to 10% of women of reproductive age and have a significant impact on quality of life. It discussed the challenges of diagnosing deep pelvic endometriosis, particularly the rectosigmoid involvement, and highlighted transvaginal ultrasound as a valuable imaging tool for its assessment. The paper also provided a comprehensive assessment of the methodological quality of the studies included in the meta-analysis, focusing on the technical details, diagnostic criteria, and potential biases.

- The clinical implications of the study findings suggested that transvaginal ultrasound with bowel preparation alone might be the best method for diagnosing rectosigmoid endometriosis, considering the invasiveness of the method with rectal water contrast. The need for better quality studies using uniform definition criteria in a larger series of patients to validate the preliminary results was emphasized. The conclusion highlighted the importance of further research to validate the results and optimize the diagnosis of endometriosis rectosigmoid.

Reference –

Maderuelo S, Satorres E, Arrufat T, Lourenço M, Novillo-Del Álamo B, Guerriero S, Luis Alcazar J. Transvaginal ultrasound with bowel preparation versus transvaginal ultrasound with bowel preparation and water contrast for diagnosing Recto-Sigmoid endometriosis. A systematic review and Meta-Analysis. Eur J Obstet Gynecol Reprod Biol. 2024 Jun;297:233-240. doi: 10.1016/j.ejogrb.2024.04.015. Epub 2024 Apr 12. PMID: 38696910.