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Ultraschall Med
DOI: 10.1055/a-2209-5653
Original Article

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

Sonomorphologische Veränderungen bei tief-infiltrierender kolorektaler Endometriose: Der Langzeiteffekt von Alter und hormoneller Therapie
Simon Keckstein 
1   Department of Obstetrics and Gynecology, LMU University Hospital, Munich, Germany (Ringgold ID: RIN9183)
,
Juergen Dippon
2   Institute for Stochastics and Applications, University of Stuttgart, Stuttgart, Germany (Ringgold ID: RIN9149)
,
Gernot Hudelist
3   Gynaecology, Hospital St. John of God, Vienna, Austria
,
Philippe Koninckx
4   Department for Gynecology, Latifa Hospital, Dubai, United Arab Emirates (Ringgold ID: RIN525328)
,
George Condous
5   Acute Gynecology, Early Pregnancy & Advanced Endoscopic Surgery Unit, University of Sydney - Sydney Medical School Nepean, Sydney, Australia (Ringgold ID: RIN216996)
,
Lennard Schroeder
1   Department of Obstetrics and Gynecology, LMU University Hospital, Munich, Germany (Ringgold ID: RIN9183)
,
Joerg Keckstein
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 (Ringgold ID: RIN27197)
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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.

Zusammenfassung

Ziel Das Wachstumsverhalten tief-infiltrierender Endometriose bei Frauen im reproduktionsfähigen Alter variiert stark. Ziel dieser Studie war es, die sonomorphologischen Veränderungen einer rektalen Endometriose im zeitlichen Verlauf zu analysieren und den Einfluss einer Hormontherapie zu untersuchen.

Material und Methoden In dieser retrospektiven Studie wurden prämenopausale Frauen mit rektosigmoidaler Endometriose eingeschlossen, die zwischen 2002 und 2021 primär konservativ behandelt wurden. Hierzu wurden Länge und Dicke der Herde in regelmäßigen Abständen sonographisch gemessen. Um Faktoren zu identifizieren, welche das Wachstumsverhalten beeinflussen könnten, wurden „Mixed-effect“-Modelle zur statistischen Analyse angewandt.

Ergebnisse Achtunddreißig Patientinnen wurden über einen Zeitraum von 7,2 (± 4,2) Jahren mit einer durchschnittlichen Anzahl von 3,1 (± 2,1) Untersuchungen überwacht. Wir konnten eine signifikante Zunahme der Herdlängen bis zum Ende des vierten Lebensjahrzehnts feststellen. Abhängig von der Dauer der Hormonbehandlung zeigte sich eine signifikante Abnahme der Länge und Dicke der Herde.

Schlussfolgerung Bei konservativ behandelten Patientinnen mit rektosigmoidaler Endometriose, ohne hormonelle Therapie, kann die Größe der Läsionen bis zum Ende des vierten Lebensjahrzehnts moderat zunehmen. Danach scheint diese sich zu stabilisieren. Die hormonelle Therapie kann eine weitere Progression des Wachstums verhindern und führt bei längerer Einnahme sogar zu einer Regression der Herde.

Keywords

deep infiltrating endometriosis - transvaginal sonography - hormonal therapy - bowel endometriosis - long-term observation

Supporting information



Publication History

Received: 08 August 2023

Accepted after revision: 06 November 2023

Article published online:
15 December 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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