Endometriosis beyond the Pelvis: A Case Series of Cutaneous Endometriosis and Literature Review

Introduction: Cutaneous endometriosis is an uncommon but well-known skin disorder that represents about 0.5% to 1% of all endometriosis. The objective of this case series is to report clinical presentation, diagnosis, and management of various forms of cutaneous endometriosis. Material and Methods: It was an observational, retrospective and descriptive review of cases presenting with cutaneous endometriosis among Cameroonian women managed at the gynaecological outpatient department of Yaounde Gynaeco-Obstetric and Pediatric Hospital. All the following parameters were analysed: age, parity, previous pelvic surgery, presenting symptoms and duration, associated symptoms, localizations, imaging, size of the lesion, other localization of endometriosis, management and histopathological results. Results: we reported 4 cases of cutaneous endometriosis, with 3 umbilical endometriosis and 1 abdominal scar endometriosis. Patient age ranged from 28 to 39 years with an average of 33 years. All patients described infertility (two primary and two secondary) and two had a history of abdominal surgery. All patients presented local cyclical signs such as pain, swelling, color change and bleeding. The duration of symptoms varied from 2 to 3 years and the size of lesions ranged from 2 to 3.5 cm for umbilical lesions and was 9 cm for abdominal scar endometriosis. In all cases, no imaging was required for the diagnosis, which was suspected on the basis of patient’s history and the cyclical nature of local signs, followed by wide surgical excision and confirmation on histopathology. Conclusion: Cutaneaous endometriosis is a rare benign condition. Umbilical endometriosis seems to be the main cutaneous localization and can be described as primary or secondary. Even if its diagnosis must be confirmed by histopathology, it should be considered in patient with cutaneous cyclic signs such as pain, swelling or bleeding with or without history of abdominal surgery.

Immune pathway through endometriosis to ovarian cancer

Endometriosis is an estrogen-dependent inflammatory disease,defined by the presence of functional endometrial tissue outside of the uterine cavity.This disease is one of the main gynecological diseases,affecting around 10%-15%women and girls of reproductive age,being a common gynecologic disorder.Although endometriosis is a benign disease,it shares several characteristics with invasive cancer.Studies support that it has been linked with an increased chance of developing endometrial ovarian cancer,representing an earlier stage of neoplastic processes.This is particularly true for women with clear cell carcinoma,low-grade serous carcinoma and endometrioid.However,the carcinogenic pathways between both pathologies remain poorly understood.Current studies suggest a connection between endometriosis and endometriosis-associated ovarian cancers(EAOCs)via pathways associated with oxidative stress,inflammation,and hyperestrogenism.This article aims to review current data on the molecular events linked to the development of EAOCs from endometriosis,specifically focusing on the complex relationship between the immune response to endometriosis and cancer,including the molecular mechanisms and their ramifications.Examining recent developments in immunotherapy and their potential to boost the effectiveness of future treatments.

Vaginal endoscopy combined with gonadotropin-releasing hormone agonist successfully treated a patient with cervical endometriosis:a case report

A 36-year-old unmarried woman with no sexual history presented with 12 days of uncontrollable yellowish vaginal discharge,bloating,lower back pain,frequent urination,and urgency.Her menstrual cycles were regular with moderate flow and worsening dysmenorrhea.Ultrasound and magnetic resonance imaging identified uterine and cervical masses.Laparoscopic surgery and postoperative gonadotropin-releasing hormone agonist injections led to significant lesion reduction.The patient is currently on oral dienogest acetate with ongoing follow-up.

Distinct molecular targets of ProEGCG from EGCG and superior inhibition of angiogenesis signaling pathways for treatment of endometriosis

Endometriosis is a common chronic gynecological disease with endometrial cell implantation outside the uterus.Angiogenesis is a major pathophysiology in endometriosis.Our previous studies have demonstrated that the prodrug of epigallocatechin gallate(ProEGCG)exhibits superior anti-endometriotic and anti-angiogenic effects compared to epigallocatechin gallate(EGCG).However,their direct binding targets and underlying mechanisms for the differential effects remain unknown.In this study,we demonstrated that oral ProEGCG can be effective in preventing and treating endometriosis.Additionally,1D and 2D Proteome Integral Solubility Alteration assay-based chemical proteomics identified metadherin(MTDH)and PX domain containing serine/threonine kinase-like(PXK)as novel binding targets of EGCG and ProEGCG,respectively.Computational simulation and BioLayer interferometry were used to confirm their binding affinity.Our results showed that MTDH-EGCG inhibited protein kinase B(Akt)-mediated angiogenesis,while PXK-ProEGCG inhibited epidermal growth factor(EGF)-mediated angiogenesis via the EGF/hypoxia-inducible factor(HIF-1a)/vascular endothelial growth factor(VEGF)pathway.In vitro and in vivo knockdown assays and microvascular network imaging further confirmed the involvement of these signaling pathways.Moreover,our study demonstrated that ProEGCG has superior therapeutic effects than EGCG by targeting distinct signal transduction pathways and may act as a novel antiangiogenic therapy for endometriosis.

Acute abdominal pain from ovarian endometriosis

Endometriosis is a common,estrogen-dependent,inflammatory,gynecologic disease process in which normal endometrial tissue is abnormally present outside the uterine cavity.[1]Endometriosis is a common cause of chronic pain,dyspareunia,dysmenorrhea,and infertility.Most commonly,endometriosis is found within the pelvis,specifically on the ovaries.Because of rupture,bleeding,infection,or torsion,ovarian endometriosis(OMA)may cause acute abdominal pain,which is similar to acute abdominal pain caused by other reasons and is not easy to diagnose.[2,3]Determining the clinical and pathological features of OMA is crucial for accurate assessment,diagnosis,and treatment.

Can Tibetan medicine Honghua Ruyi pills relieve endometriosisassociated dysmenorrhea?Protocol for a randomized placebocontrolled trial

Objective:To provide high-quality clinical evidence of the efficacy of Tibetan medicine Honghua Ruyi(HHRY)pills for endometriosis-associated dysmenorrhea.Methods:This study constitutes a multicenter,randomized,double-blind,placebo-controlled trial encompassing a three-menstrual cycle intervention followed by a three-menstrual cycle follow-up period.A total of 164 eligible females with endometriosis-associated dysmenorrhea were randomly divided into HHRY pills and placebo groups in a 1:1 ratio.The primary outcome included dysmenorrhea symptoms assessed using Visual Analog Scale(VAS)scores and quality of life,whereas the secondary outcome measures included the maximum VAS for non-menstrual pelvic pain,duration of pain episodes(in days),frequency and quantity of the consumption of ibuprofen sustained-release capsules(or other non-steroidal anti-inflammatory drugs),and days off work/study for staff/student due to dysmenorrhea,ovarian cyst,and/or pelvic nodule size.The safety was monitored throughout the treatment period.All the analyses were based on the intention-to-treat principle.For continuous outcomes,simple or multiple linear regressions were used to estimate the differences between the HHRY pills and placebo groups,with categorical data expressed as the number and percentage of occurrences.Differences were compared using the chi-square test or Fisher's exact test.The predefined analysis was adjusted for concomitant treatment,a variable considered to be associated with outcomes but unaffected by treatment allocation.Estimates of treatment effects were reported with 95%confidence intervals.Two-tailed P values≤.05 were considered statistically significant.Conclusion:Positive results from this trial,upon completion would provide robust evidence for the efficacy and safety of HHRY pills in treating dysmenorrhea in patients with endometriosis.

Comparison of ovarian preservation versus oophorectomy on fertility outcomes in patients with endometriosis post-laparoscopic surgery:A prospective study

BACKGROUND Endometriosis is a chronic inflammatory condition affecting a significant proportion of women of reproductive age.Although laparoscopic surgery is commonly the preferred treatment,the decision to preserve or remove the ovaries remains controversial.Previous studies have yielded inconsistent results regarding the impact of ovarian preservation vs oophorectomy on fertility outcomes and disease recurrence.This prospective study aimed to address this knowledge gap by comparing the effects of these surgical approaches on spontaneous pregnancy rates,time to pregnancy,recurrence rates,and postoperative pain in patients with endometriosis.AIM To compare the reproductive outcomes and recurrence rates between ovarian preservation and oophorectomy in women undergoing laparoscopic surgery for endometriosis.METHODS This study was conducted at a tertiary care hospital between January 2019 and December 2023.A total of 312 women aged 18 to 40 years,diagnosed with endometriosis and undergoing laparoscopic surgery,were included.The patients were categorized into the ovarian preservation group(n=204)and the oophorectomy group(n=108).The primary outcome measure was the achievement of spontaneous pregnancy within 24 months post-surgery.Secondary outcomes included time to spontaneous pregnancy,recurrence rates,and postoperative pain scores.RESULTS The ovarian preservation group exhibited a significantly higher spontaneous pregnancy rate than that in the oophorectomy group(43.6%vs 28.7%,P=0.006).Moreover,the median time to spontaneous pregnancy was shorter in the ovarian preservation group(8.2 months vs 11.4 months,P=0.018).Nonetheless,endometriosis recurrence was more prevalent in the ovarian preservation group(22.1%vs 11.1%,P=0.014).The postoperative pain scores demonstrated similar improvements in both groups,with no significant differences observed.Subgroup analyses indicated that the benefit of ovarian preservation on spontaneous pregnancy rates was more evident among younger women(≤35 years)and those with advanced-stage endometriosis.CONCLUSION Ovarian preservation is associated with a high spontaneous pregnancy rate and a short time to pregnancy.However,because of the increased risk of recurrence,the decision should be based on age,fertility aspirations,and disease severity.

Effect of dienogest treatment on uterine fibroid volume in patients with endometriosis or adenomyosis complicated by uterine fibroids

BACKGROUND Currently,the use of dienogest in clinical practice has increased significantly,and many studies have focused on its effectiveness and safety in the treatment of endometriosis and adenomyosis;however,the effects of treatment with dienogest on uterine fibroid size in patients with endometriosis or adenomyosis have not been investigated.AIM To explore changes in fibroid size in patients with concomitant uterine fibroids undergoing dienogest treatment for endometriosis or adenomyosis and to evaluate the effectiveness and safety of the drug.METHODS The clinical data of patients with uterine fibroids treated with dienogest for endometriosis or adenomyosis at Peking University First Hospital from January 2021 to January 2023 were retrospectively analyzed.RESULTS The maximum uterine fibroid diameter and volume increased after 3 months,6 months and 1 year of dienogest treatment compared with those before treatment(P<0.01).The maximum diameter and volume of the uterine adenomyoma increased after 3 months of dienogest treatment but decreased after 6 months and 1 year of treatment compared with those before treatment,but the difference was not significant(P>0.05).Endometrial thickness and antigen 125 levels were significantly thinner and decreased,respectively,after dienogest treatment(P<0.01).Pearson's correlation analysis revealed that the increase in uterine fibroid volume after 3 months of dienogest treatment was positively correlated with the basic uterine fibroid volume(r=0.792,P<0.01).Among 64 patients with dysmenorrhea,63 experienced significant relief of dysmenorrhea after 6 months of treatment with dienogest,and all patients experienced significant relief of dysmenorrhea after 12 months.Patients were able to tolerate the drugs,with an average drug tolerance score of 8.73.CONCLUSION The use of dienogest in patients with endometriosis or adenomyosis combined with uterine fibroids can effectively relieve the patient's pain symptoms and significantly reduce the sizes of ovarian endometriotic cysts,but it cannot inhibit uterine fibroid growth.

Analysis of risk factors for postoperative anxiety and depression in endometriosis patients with reproductive intention

BACKGROUND The occurrence of postoperative depression and anxiety in patients with endomet-riosis(EMS)not only causes psychological distress,but may also harm their physical health.AIM To explore the postoperative depression status,and its influencing factors,of EMS patients with reproductive intention.METHODS A total of 321 EMS patients with reproductive intent were included.Using the self-rating anxiety scale and self-rating depression scale,EMS patients with anxiety or depression were distinguished.A clinical model for predicting anxiety or depression in EMS patients was constructed and evaluated using a nomogram,receiver operating characteristic curve,and calibration curve.RESULTS The results of the single factor analysis showed that smoking,coffee,EMS stage,chronic pelvic pain,and sexual discomfort may be related to anxiety.Further,smoking,drinking,spouse,annual household income and EMS stage may be related to depression in EMS patients.Multivariate logistic regression illustrated that smoking,coffee,chronic pelvic pain and sexual discomfort may be inde-pendent risk factors for anxiety in EMS patients,while smoking,EMS stage(Phase III and Phase IV),spouse and high annual household income may be independent risk factors for depression in EMS patients.Additionally,the models used to predict the risk of anxiety or depression in EMS patients have good predictive value.CONCLUSION The anxiety and depression of EMS patients may be related to many factors.In clinical treatment,additional attention should be paid to the psychological status of EMS patients.

Clinical Effectiveness of Dienogest in the Treatment of Endometriosis

Objective:This paper aims to investigate the efficacy of desogestrel in the treatment of endometriosis.Methods:In this study,61 patients with endometriosis in our hospital from January 2023 to December 2023 were selected and divided using the random sampling method.All the patients were treated with desogestrel and the pain symptom scores and HDL-C(high-density lipoprotein cholesterol)levels of the patients were compared before and after the treatment.The treatment effects and adverse effects during the administration of the drug were closely observed.Results:After the patients were treated with desogestrel,the effective rate of treatment was as high as 98.36%,and the incidence of adverse reactions during treatment was 6.55%.Compared with the pre-treatment period,the scores of various pain symptoms were significantly reduced and the HDL-C level was improved after treatment,with P<0.05.Conclusion:Desogestrel showed significant efficacy in the treatment of endometriosis,effectively relieving patients’pain while elevating HDL-C levels.In addition,the incidence of adverse reactions to this drug is relatively low,which is worth utilizing.

Deep endometriosis with pericolic lymph node involvement: A case report and literature review

Deep infiltrating endometriosis is an often-painful disorder affecting women during their reproductive years that usually involves the structures of the pelvis and frequently the gastrointestinal tract.We present the case of a 37-year-old female patient with an endometrial growth on the sigmoid colon wall causing pain,diarrhea and the presence of blood in the feces.The histology of the removed specimen also revealed the involvement of the utero-vesical fold,the recto-vaginal septum and a pericolic lymph node,which are all quite uncommon findings.To identify the endometrial cells,we performed immunohistochemical staining for CD10and the estrogen and progesterone receptors.

Bowel endometriosis: Colorectal surgeon's perspective in a multidisciplinary surgical team

Endometriosis is a gynecological condition that presents as endometrial-like tissue outside the uterus and induces a chronic inflammatory reaction. Up to 15% of women in their reproductive period are affected by this condition. Deep endometriosis is defined as endometriosis located more than 5 mm beneath the peritoneal surface. This type of endometriosis is mostly found on the uterosacral ligaments, inside the rectovaginal septum or vagina, in the rectosigmoid area, ovarian fossa, pelvic peritoneum, ureters, and bladder, causing a distortion of the pelvic anatomy. The frequency of bowel endometriosis is unknown, but in cases of bowel infiltration, about 90% are localized on the sigmoid colon or the rectum. Colorectal involvement results in alterations of bowel habits such as constipation, diarrhea, tenesmus, dyschezia, and, rarely, rectal bleeding.Differential diagnosis must be made in case of irritable bowel syndrome,solitary rectal ulcer syndrome,and a rectal tumor.A precise diagnosis about the presence,location,and extent of endometriosis is necessary to plan surgical treatment.Multidisciplinary laparoscopic treatment has become the standard of care.Depending on the size of the lesion and site of involvement,fullthickness disc excision or bowel resection needs to be performed by an experienced colorectal surgeon.Longterm outcomes,following bowel resection for severe endometriosis,regarding pain and recurrence rate are good with a pregnancy rate of 50%.

Intestinal endometriosis-A rare cause of colonic perforation

Endometriosis is the ectopic growth of viable endometrium outside the uterus, affecting approximately 7% of females. It commonly affects pelvic structures including the bowel. Perforation of the colon by endometriosis is very rare and the patients generally present with an asymptomatic or painful pelvic mass, often in the left iliac fossa. Our patient presented acutely unwell and her symptoms were more suggestive of pyelonephritis or diverticulitis. We therefore report an unusual cause of acute abdomen. The purpose of the following case report is to elucidate certain diagnostic and therapeutic problems of the disease, concerning both surgeons and gynaecologists. In summary, intestinal endometriosis should be considered in the differential diagnosis of all post-menarche women with episodic gastrointestinal symptoms. A past history of endometriosis or co-existent gynaecological symptoms should increase the index of suspicion, and taparoscopy prior to formal laparotomy should be considered. Our patient, in retrospect, had a history of mild endometriosis, but we feel that this case serves as a reminder of a rare, but important, differential diagnosis of acute abdomen in females.

Inguinal endometriosis: Ten case reports and review of literature

BACKGROUND To describe the characteristics,diagnosis and surgical treatment of inguinal endometriosis(IEM).CASE SUMMARY We retrospectively analyzed 10 patients diagnosed with IEM at Beijing Chao-Yang Hospital from 2011 to 2019.Relevant features,symptoms,images,surgical treatment,hormonal therapy and follow-up were collected and discussed.A total of 10 cases of IEM diagnosed by surgery and pathology were characterized by a lesion on the right side(9/11);five patients had symptoms related to the menstrual cycle,and only 3 patients were clearly diagnosed before surgery.Ultrasonography was of little assistance in confirming the diagnosis,but magnetic resonance imaging showed specific,high-intensity patterns.Anatomically,most of the IEM lesions were located in the extraperitoneal ligament(10/11);nine patients had inguinal hernias(IH),five had concurrent or prior pelvic endometriosis,and four had infertility.The clinical results from extensive resection were satisfactory.CONCLUSION IEM is an extremely rare condition that can easily be misdiagnosed prior to surgery.A right IH may contribute to the formation of right-sided IEM,and extensive resection involving the round ligament and hernia sac is essential to prevent recurrence.

Robotic Assisted Surgery for Endometriosis—“Is the Way Forward?”

Endometriosis is a chronic and progressive gynecologic disorder that affects 10% - 50% of women of reproductive age worldwide. Chronic pain and infertility are the most debilitating problems associated with it requiring both medical and surgical treatment. Laparoscopy is considered the gold standard for diagnosis and treatment. However, a 10% rate of conversion to laparotomy has been reported when performed by skilled laparoscopic surgeons and much higher in low volume less skilled surgeons. To improve surgical outcomes, robotic assistance is the logical next step in performing minimally invasive gynecological surgeries, especially in complex endometriosis cases. Enhanced 3D visualization and 10× magnification along with Endowrist instruments with seven degrees of freedom facilitates precise and careful dissection. Firefly technology using ICG green dye can improve detection of small and invisible lesions. Robotics is useful in deep infiltrating disease manifesting as lesions deeper than the superficial tissues of rectovaginal septum, vaginal fornix, pelvic sidewalls, parametrium, bowel or ureter and bladder. Trials show no increase in surgical time, blood loss, or intra- or postoperative complications and similar clinical outcome when robotics is compared with laparoscopy. At present, it is more appropriate to compare it with laparotomy rather than laparoscopy. Robotics can be used to manage recurrence of endometriosis after hysterectomy. Surgeons experienced in conventional laparoscopy can utilize robotic platform for deep infiltrating endometriosis for performing complex surgical dissection and achieving the surgical goals in mind and reduce conversions to open surgery. Robotic assistance can bridge the gap in performance of laparoscopic surgery in advanced endometriosis.

Rectal Endometriosis Revealed by a Colonic Tumor Obstruction: A Case Report

Endometriosis is defined as the presence of endometrial tissue that is located outside the uterine cavity, associated with fibrosis and inflammatory reaction. The most common atypical locations are the gastrointestinal tract, urinary tract, lung, as well as abdominal surgical scars. Its diagnosis is still very difficult, especially when it manifests itself as an acute large bowel obstruction. We report the rare case of a 41-year-old patient diagnosed with acute colonic obstruction following a rectal tumor. She had undergone colonostomy even though colonoscopy biopsies were nonspecific, and a computed tomography (CT) scan was requested. It showed an adnexal heterogenous mass, therefore the patient had a laparotomy and a subtotal hysterectomy with bilateral salpingo-oophorectomy and a biopsy of the recto-colonic hinge. Histologic examination revealed a diagnosis of rectal endometriosis. The purpose of this work is to report a rare case of colonic endometriosis responsible for an acute large bowel obstruction.

Endometriosis of the Sigmoid Colon Mimicking Malignant Lesion

Endometriosis is defined as the presence of endometrial tissue outside the uterus. It is a benign pathology involving 15% of women of reproductive age. The sigmoid site represents 7% of endometriosis but it is the most frequent area in the digestive tract. We report two cases of colonic endometriosis in which the initial diagnosis suspected a malignant disease. Respectively, the patients were 31 and 48 years old. The first patient complained about abdominal pain with symptoms of intestinal obstruction and was classified after radiological examination as an intrasigmoid tumor with bladder adhesion. The second patient was undergone for a radiological examination because of a bowel obstruction syndrom and a mass in the sigmoid colon was suspected. In both cases, sigmoid colon resection was performed and histological diagnosis was sigmoid endometriosis. Sigmoid endometriosis is rarely diagnosed before surgical excision. Suspicious bowel obstruction and malignant origin lead to large surgical excision. Histological examination is important to establish the diagnosis.

Expression of MMIF, HIF-1α and VEGF in Serum and Endometrial Tissues of Patients with Endometriosis

The aim of this study was to investigate the expression of macrophage migration inhibitory factor （MMIF）, hypoxia-inducible factor- 1 α（HIF- 1α ）and vascular endothelial growth factor （VEGF） in the serum and endometrial tissues of patients with endometriosis （EM） and the clinical significance. Eighty EM patients [American Reproductive Association stage Ⅰ （n=20）, stage Ⅱ （n=22）, stage Ⅲ （n=21） and stage Ⅳ （n=17）] were enrolled and divided into mild （10- 14 points, n=28）, moderate （16-24 points, n=27） and severe （26-30 points, n=25） dysmenorrhea groups. The control group included 40 healthy women of childbearing age who underwent routine healthcare examinations in the enrolment period. The expression of MMIF, HIF- 1α and VEGF in the serum and endometrial tissues was measured by enzyme-linked immunosorbent assay and Western blotting, respectively. Meanwhile, the sensitivity and specificity of serum MMIF, HIF-1α, and VEGF when separately used as single indexes or jointly used as one index were examined as well. The results showed that serum concentrations of MMIF, HIF-1α, and VEGF were significantly higher in EM patients than in controls （P〈0.05）. The expression of all three proteins in both serum and endometrial tissues increased significantly with the R-AFS stage （P〈0.05） and with dysmenorrheal severity （P〈0.05）. The sensitivity and specificity of the combined detection of serum MMIF, HIF-1α, and VEGF levels were significantly higher than those of single index detection （P〈0.05）. In conclusion, the expression of MMIF, HIF-1α, and VEGF in the serum and endometrial tissues may be used to assess the stage of EM and the severity of dysmenorrhea. Combined evaluation of MMIF, HIF-1α, and VEGF significantly improves the diagnostic sensitivity and specificity.

Intrahepatic endometriosis as differential diagnosis: Case report and literature review

Intrahepatic endometriosis is one of the rarest forms of atypical endometriosis; only eighteen cases have been reported in the English literature. We describe the case of a 32-year-old woman, who presented with persistent, non-cyclical upper right quadrant abdominal pain, a central liver cyst, and no history of endometriosis. Three years previous, she was diagnosed with an intrahepatic cyst. The lesion progressed and two laparoscopic deroofing-operations were performed, yet the diagnosis of intrahepatic endometriosis was never reached. She presented in our clinic with further progress of the cyst as well as obstruction of the intrahepatic biliary system. The magnetic resonance imaging showed a 9.5 cm × 12 cm, lobulated intrahepatic cyst. We performed an ultrasonic pericystectomy. Immunostaining confirmed intrahepatic endometriosis. Only one of the previously described eighteen patients with intrahepatic endometriosis presented with cyclical pain in the upper right abdominal quadrant accompanying menstruation. This lack of a "typical" clinic makes it challenging to diagnose extragonadal endometriosis without histopathology. A previous history of endometriosis was described in only twelve cases, thus the diagnosis of this condition should not be limited to patients with a known history of endometriosis. Six of 18 patients were postmenopausal, demonstrating this condition is not limited to women of reproductive age. A preoperative diagnosis was only reached in seven of the previously described cases, highlighting the importance of preoperative biopsies. Yet due to the potential adverse effects, a transhepatic biopsy must be discussed individually. Although rare, intrahepatic endometriosis should always be considered as a differential diagnosis in women with recurrent hepatic cysts, regardless of age or previous medical history. In such cases, histology is essential and a pericystectomy should be performed as standard of care.

Preoperative rectosigmoid endoscopic ultrasonography predicts the need for bowel resection in endometriosis

BACKGROUND Rectosigmoid endometriosis is an underdiagnosed disease responsible for abdominal pain, transit disorders and rectal bleeding. Two surgical approaches,rectosigmoid bowel resection(segmental or patch) or intramuscular layer dissection(shaving), are available.AIM To assess whether the lesion features observed via preoperative rectosigmoid endoscopic ultrasonography(RS-EUS) might predict the need for bowel resection.METHODS This multicentric retrospective study was conducted on patients with rectosigmoid endometriosis who underwent a curative surgical procedure,evaluated by RS-EUS performed by two trained operators, between January 2012 and March 2018. A univariate statistical analysis was performed on nodules' RSEUS features(thickness, width, infiltration of the submucosae, presence of a bump into the digestive lumen and presence of multiple rectosigmoid localizations). A multivariate logistic regression was then performed on the significant results.RESULTS Of the 367 patients, 73 patients with rectosigmoid endometriosis were evaluated by RS-EUS and underwent rectosigmoid surgery. After the univariate analysis was completed, thickness, width and infiltration of the submucosae were identified as potential predictive factors for bowel resection. In a multivariate logistic regression model, only thickness appeared to be a significant [odds ratio(OR) = 1.49, 95% confidence interval(CI): 1.04-2.12, P = 0.028] predictive factor for bowel resection. Receiver operating characteristic analysis performed showed that a thickness over 5.20 mm might be used as cut-off with a sensitivity of 76%, a specificity of 81%, and an area under carve = 0.82. The cut-off values for 100%sensitivity and 100% specificity were 0.90 mm and 10.00 mm, respectively. A trend concerning width to predict the need for resection was also observed(OR1.12, 95%CI: 1.00-1.26, P = 0.054)CONCLUSION The presence of a rectosigmoid nodule of endometriosis greater than 5.20 mm thick on RS-EUS might predict the need for bowel resection.