Long-term insights: Seven years of conservative management for deep endometriosis in the bowel

Deep endometriosis (DE) involving the bowel presents a complex management challenge. While surgery is often emphasized, limited evidence exists on long-term outcomes of conservative (non-surgical) management. This study aimed to evaluate quality of life (QoL), symptoms, bowel, and urinary function in patients with bowel DE managed conservatively over a nearly 7-year period. A secondary aim was to compare initial characteristics of those who later underwent surgery versus those who remained conservatively treated.

Patients diagnosed with bowel DE and managed conservatively with hormonal therapy were originally enrolled in a prospective study and followed up nearly 7 years later. Follow-up data were collected using validated online questionnaires: Short Form Health Survey 36 (SF-36) and Endometriosis Health Profile-30 (EHP-30) for QoL; the Low Anterior Resection Score (LARS) for bowel function; and the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) for urinary symptoms. Patients who had entered menopause or undergone bowel surgery or oophorectomy were excluded, as were patients pregnant at the time of follow-up. For the analysis related to the secondary aim, data collected 1 year from baseline was used, assessing any differences between those who later required surgery and those who remained conservatively managed.

Fifty-two patients remained on conservative management throughout the follow-up. QoL (SF-36 and EHP-30) and bowel/urinary symptoms (LARS, ICIQ-FLUTS) remained stable. A significant reduction in dysmenorrhea was observed, while intermenstrual pain and dyschezia remained unchanged. Painkiller use tended to decrease. At follow-up, 15% reported major LARS. Seventy-three patients were included in the secondary analysis. Among respondents, 19% (n = 14) underwent bowel resection or total oophorectomy during the follow-up. These patients had significantly larger bowel lesions, higher pain scores, and lower SF-36 "bodily pain" scores, reflecting poorer QoL compared to those who remained conservatively managed.

Over nearly 7 years of follow-up, most patients with bowel DE managed conservatively maintained stable symptoms and a relatively high QoL. One fifth required surgery, and these patients exhibited worse pain and QoL years prior to intervention. Conservative hormonal therapy appears to be a viable long-term option in selected patients, underscoring the importance of individualized, symptom-oriented treatment strategies.