Sonomorphologic Changes in Colorectal Deep Endometriosis: The Long-Term Impact of Age and Hormonal Treatment

Author:

Keckstein Simon1ORCID,Dippon Juergen2,Hudelist Gernot3,Koninckx Philippe4,Condous George5,Schroeder Lennard1,Keckstein Joerg678

Affiliation:

1. Department of Obstetrics and Gynecology, LMU University Hospital, Munich, Germany

2. Institute for Stochastics and Applications, University of Stuttgart, Stuttgart, Germany

3. Gynaecology, Hospital St. John of God, Vienna, Austria

4. Department for Gynecology, Latifa Hospital, Dubai, United Arab Emirates

5. Acute Gynecology, Early Pregnancy & Advanced Endoscopic Surgery Unit, University of Sydney - Sydney Medical School Nepean, Sydney, Australia

6. (SEF), Stiftung Endometrioseforschung, Westerstede, Germany

7. Gynecological Clinic, Gynecological Clinic Drs Keckstein, Villach, Austria

8. Department of Obstetrics and Gynecology, Ulm University Hospital, Ulm, Germany

Abstract

Abstract Purpose The progression of deep endometriosis (DE) in women of reproductive age is highly variable. This study aimed to analyze the sonomorphological changes of rectal endometriosis over long periods of time and the influence of hormonal treatment. Methods This retrospective study included premenopausal women with rectal DE treated conservatively between 2002 and 2021. The lesion length and thickness of the nodule were evaluated at regular intervals over time. We created statistical models with mixed effects to identify potential factors influencing lesion progression and regression. Results 38 patients were monitored over a mean period of 7.2 (± 4.2) years with a mean of 3.1 (± 2.1) check-ups within the observation period. We detected a significant increase in lesion length until the end of the fourth decade of life. In addition, we found a substantial decrease in the length and thickness of the nodule depending on the length of hormonal treatment. Conclusion In conservatively managed patients with rectal endometriosis, without hormonal therapy, lesion size can exhibit a moderate increase up to the end of the fourth decade of life, after which it appears to stabilize. This increase does not follow a linear pattern. Hormonal therapy is crucial in impeding further progression, resulting in either a cessation or a regression of lesion growth.

Publisher

Georg Thieme Verlag KG

Subject

Radiology, Nuclear Medicine and imaging

Reference28 articles.

1. Progression of deep infiltrating rectosigmoid endometriotic nodules;A Netter;Human Reproduction,2019

2. Endometriosis: pathogenesis and treatment;P Vercellini;Nature Reviews Endocrinology,2014

3. Pathogenesis of deep endometriosis;S Gordts;Fertility and sterility,2017

4. The epidemiology of endometriosis is poorly known as the pathophysiology and diagnosis are unclear;PR Koninckx;Best Pract Res Clin Obstet Gynaecol,2021

5. Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis;MS Abrao;Human Reproduction,2007

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