To determine the optimal ultrasonographic screening method for rectal/rectosigmoid deep endometriosis: ultrasound "sliding sign", transvaginal ultrasound direct visulization or both?

Introduction The study aim was to evaluate the transvaginal sonography (TVS) “sliding sign” alone, direct visualization of the bowel with TVS, and the combination of both methods (i.e. “sliding sign” and direct visualization of the bowel), to determine the optimal TVS method for the prediction of rectal/rectosigmoid deep endometriosis (DE). Material and methods Multicentre prospective observational study (January 2009‐ February 2017). All women underwent TVS to determine whether the “sliding sign” was positive/negative and whether rectal/rectosigmoid DE was present, followed by laparoscopic surgery. The association between a negative TVS “sliding sign” alone and the direct visualization of a rectal/rectosigmoid DE nodule alone during the TVS were correlated with the presence of rectal/rectosigmoid DE at laparoscopy. Accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and likelihood ratios were evaluated. Data were analysed using Fisher's exact test. Results During the recruitment period, 410 consecutive women with suspected endometriosis were included. Complete TVS and laparoscopic surgical outcomes were available for 376/410 (91.7%) women. Complete TVS and laparoscopic data were available for 376 women. 76/376 (20.2%) women had rectal/rectosigmoid DE at laparoscopy. The accuracy, sensitivity, specificity, PPV, NPV, positive and negative likelihood ratios for each method to predict bowel DE were: negative “sliding sign”: 87%, 73.7%, 90.3%, 65.9%, 93.1%, 7.62, and 0.29, respectively, direct visualization: 91.0%, 86.8%, 92.3%, 74.2%, 96.5%, 11.3, and 0.14, respectively, and combined approach: 90.2%, 69.7%, 95.3%, 79.1%, 92.6%, 14.94 and 0.32, respectively. A negative TVS “sliding sign” was significantly associated with the need for bowel surgery (p‐value<0.05). Conclusions The combination of the TVS “sliding sign” and direct visualization of the bowel during TVS appears to provide the most accurate assessment for the identification of rectal/rectosigmoid DE pre‐operatively. This article is protected by copyright. All rights reserved