The Association between Gastrointestinal Symptoms and Transvaginal Ultrasound Findings in Women Referred for Endometriosis Evaluation: A Prospective Pilot Study

Purpose: To evaluate the relationship between gastrointestinal (GI) symptoms and transvaginal ultrasound (TVUS) findings suggestive of endometriosis. Materials and Methods: A prospective design. Women referred for a diagnostic ultrasound due to suspicion of endometriosis completed a Rome III and Pelvic Floor Distress Inventory (PFDI-20) questionnaire for clinical, GI symptoms, before undergoing TVUS. Endometriosis was diagnosed in the presence of endometriomas and/or deeply infiltrative endometriotic (DIE) lesions. Association between lesion sites and GI symptoms was evaluated by univariate and multivariate analysis. Results: The study included 241 women who presented with: dysmenorrhea (89.6%), dyspareunia (76.3%), chronic pelvic pain (77.2%), dyschezia (66%), hematochezia (15.4%), subfertility (24.5%). GI symptoms were present in 25.3-76.8% and 5.4-55.6% of Rome III and PFDI-20 questionnaire responses, respectively. TVUS findings were endometriomas (23.2%), peritoneal adhesions (46.5%), uterosacral ligament (26.7%), retrocervical (11.2%), rectosigmoid (11.2%), intestinal (4.6%), and bladder (0.8%) involvement, and pouch of Douglas (POD) obliteration (15.4%). There was a high prevalence of peritoneal adhesions, uterosacral ligament involvement, and rectosigmoid and intestinal nodules on TVUS in women with GI symptoms, up to Chi ²=9.639 (p=0.013) on univariate and Chi2=8.102 (p=0.005) on multivariate analysis. Conclusion: We observed an almost 10-fold increase in DIE lesions in women with GI symptoms. We suggest that the presence of GI symptoms should prompt a referral for endometriosis evaluation and performance of a dedicated TVUS before invasive gastrointestinal procedures.