Double-contrast barium enema and transrectal endoscopic ultrasonography in the diagnosis of intestinal deeply infiltrating endometriosis

Helizabet Salomão Abdalla Ayroza Ribeiro, Ribeiro HS, Ribeiro PA, Paulo Ayroza Ribeiro, Rossini L, Lucio Rossini, Francisco Rodrigues, Francisco Cesar Rodrigues, Rodrigues FC, Nilson Donadio, Donadio N, Tsutomu Aoki, Aoki T
Journal of Minimally Invasive Gynecology · 2008 · vol. 15(3) , pp. 315–320 · doi:10.1016/j.jmig.2008.02.001 · PMID:18439504 · W2025047136
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This study compared double-contrast barium enema and transrectal endoscopic ultrasonography for diagnosing intestinal deeply infiltrating endometriosis.

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Abstract

STUDY OBJECTIVE: To evaluate the sensitivity, specificity, negative predictive value, positive predictive value, association, and agreement of double-contrast barium enema (DCBE) and transrectal endoscopic ultrasonography (Tr EUS) in the diagnosis of rectosigmoid colon endometriosis. DESIGN: Prospective nonrandomized (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: We evaluated 37 patients with clinically suspected deeply infiltrating endometriosis (DIE) from January 2004 through January 2005. INTERVENTIONS: Clinical examination, DCBE, Tr EUS, and laparoscopy for histologic confirmation. MEASUREMENTS AND MAIN RESULTS: 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 Tr EUS in 28 patients (75.7%). Considering the DCBE findings we observed among the 24 abnormal examination results, 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 was 54%, the negative predictive value (NPV) was 70%, and the positive predictive value (PPV) was 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 = .017) and a moderate agreement of the methods (kappa = 0.44) was also observed. CONCLUSION: Our data, although limited by sample size, confirmed that DCBE has a good sensitivity and a low specificity in the diagnosis of intestinal DIE. The Tr EUS proved to have a higher sensitivity and specificity with elevated NPV and PPV. A significant association of the DCBE and the Tr EUS in the diagnosis of intestinal DIE and a moderate agreement of the methods was also observed.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Gastrointestinal Diseases Adult Adult Barium Sulfate Barium Sulfate Endometriosis Endometriosis Endosonography Endosonography Endosonography Female Female Gastrointestinal Diseases Gastrointestinal Diseases Humans Humans Middle Aged Middle Aged Predictive Value of Tests

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