Bowel preparation prior to transvaginal ultrasound improves detection of rectosigmoid deep infiltrating endometriosis and is well tolerated: prospective study of women with suspected endometriosis without surgical criteria

Abstract

Objective The main objective was to describe the effect of bowel preparation (BP) prior to transvaginal ultrasound scan (TVUS) in detecting bowel involvement and describing rectosigmoid nodules of deep infiltrating endometriosis (DIE). The secondary objective was to describe the tolerance of BP. Methods A prospective study of paired data was designed. A cohort of women referred for the first time to the Endometriosis Unit in a tertiary university hospital from September 2015 to March 2016 was included. In all patients, the wall of the rectum and lower sigmoid colon was evaluated by 2 TVUS: 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. Number and size of rectosigmoid nodules, deepest layer of the rectum affected, circumference of the bowel affected and distance from anal verge were determined. Tolerance to BP was also recorded using a five‐point Likert scale. Results The mean age of the patients included in the study was 36.8 ± 5.07 years. Up to 55% of thepatients identified with adherences to the serosa layer in the first TVUS without BP were evaluated as having real rectosigmoid nodules after TVUS with BP, and up to 22 additional nodules were observed in TVUS with BP. These newly detected rectosigmoid nodules, first assessed as adherences, were smaller and more superficial. Finally, the overall tolerance to BP was 1.81 in a 5‐point Likert scale, being 1 “very well tolerated” and 5 “very poor tolerated”. Conclusions BP is well tolerated by patients. When BP is performed before TVUS, it improves the detection of small and superficial nodules and those in the anterior sigmoid wall, and allows a better detailed description of them in patients with suspected endometriosis.