P18.06: Bowel preparation prior to transvaginal ultrasound improves the diagnosis of rectosigmoid deep infiltrating endometriosis: a prospective study

Abstract

To compare the accuracy of transvaginal ultrasound (TVUS) with and without bowel preparation (BP) to detect and describe intestinal nodules of deep infiltrating endometriosis (DIE) with laparoscopic findings. The wall of the rectum and lower sigmoid colon of patients awaiting surgery for endometriosis was evaluated by 2 TVUS (type RIC5-9, Voluson-V730 Expert, GE, Germany): the first ultrasound was performed without previous BP and the second was done after a three-day low-residue diet and two 250 ml enemas 12h and 3h before TVUS. The number and localisation of rectosigmoid nodules visualised by TVUS with and without BP were compared with laparoscopic results. 40 patients with a mean age of 36.8±5.0 years were included in the study. On comparing the surgical findings (number, localisation and depth of bowel nodules) with those of the two TVUS with and without BP, the sensitivity, specificity and Cohen's kappa (k) were 100%, 96% and k=0.95; and 73%, 81% and k=0.55, respectively. Laparoscopy showed that up to 37.5% of patients (15/40) presented bowel involvement. Variables were clearly more “evaluable” with than without BP. TVUS with BP has a higher accuracy than TVUS without BP. BP allows and facilitates the detection of more rectal nodules of DIE in patients with suspected endometriosis and surgical criteria.