239: Double-Contrast Barium Enema and Transrectal Endoscopic Ultrasonography in the Diagnosis of Intestinal Deeply Infiltrating Endometriosis

Abstract

To evaluate the accuracy of Double-Contrast Barium Enema (DCBE) and Transrectal Endoscopic Ultrasound (Tr EUS) in the diagnosis of rectosigmoid colon endometriosis. Prospective non randomized (Canadian Task Force Classification II-3). University Hospital. We evaluated 37 patients with clinically suspected deeply infiltrating endometriosis from January 2004 to January 2005. Clinical examination, double-contrast barium enema, transrectal endoscopic ultrasound and laparoscopy for histological confirmation. Deeply infiltrating endometriosis was confirmed by laparoscopic visualization and by histopathologic examination in all patients. Intestinal endometriosis was observed in 27 patients (72.9%). DCBE showed abnormalities suggestive of bowel endometriosis in 24 patients (64.9%) and transrectal endoscopic ultrasonography in 28 patients (75.7%). Considering the DCBE findings we observed that among the 24 abnormal examinations, 16 (42.3%) had spiculation, 16 (42.3%) had circumferential narrowing of the bowel and 4 (10.8%) had the mass effect sign. For DCBE the sensitivity was 88%, the specificity 54%, the negative predictive value (NPV) 70% and the positive predictive value (PPV) 78%. For Tr EUS the sensitivity, specificity, NPV and PPV were 96%, 100%, 90% and 100%. A significant association of the DCBE and the Tr EUS in the diagnosis of intestinal DIE (p=0.017) and a moderate agreement of the methods (k=0.44) was also observed. Our data, although limited by sample size, confirmed that DCBE is an effective method in the diagnosis of intestinal DIE and that DCBE can predict bowel infiltration caused by endometriosis. Tr EUS proved to be highly effective on the diagnosis of intestinal endometriosis.