Deep endometriosis — a comparative study of pain syndrome and the prevalence of clinical symptoms according to the #ENZIAN classification

Deep infiltrating endometriosis (DIE) is the most aggressive and heterogeneous form of endometriosis, constituting 25% of the latter. The diagnosis of DIE presents a complex challenge in the medicine. The #ENZIAN classification, approved for clinical application, serves as a fundamental tool for diagnosing DIE. Objective. Comparation of the pain syndrome among forms of endometriosis, examination of DIE symptoms according to the #ENZIAN for improving its preoperative diagnostic. Methodology. A cohort study conducted at the G. Paladi Municipal Hospital in Chisinau during 2 years, included 190 reproductive-aged patients with endometriosis, divided into cohorts according to the #ENZIAN classification: the principal — 85 patients with DIE, the comparative — 105 women with alternative forms of endometriosis. Visual Analog Scale (VAS) and the Biberoglu and Behrman (B&B) scale were deployed for objectivization of pelvic pain. The study analyzed the correlation between the symptoms of DIE and the localization of lesions by the #ENZIAN. Statistical analyses were executed in the SPSS. Results. The intensity of the pain by VAS and B&B in patients with DIE surpassed the control cohort (p<0.01). Complaint profiles in DIE demonstrated greater heterogeneity compared to control group, encompassing heightened intensity (>7 points) and broader spectrum of pain (dysuria, dyschezia), catamenial extragenital symptoms (p<0.001). The symptomatic analysis of DIE demonstrated a statistical correlation with specific #ENZIAN compartments (p<0.05). Conclusions. A high-intensity and broad-spectrum pelvic pain syndrome, combined with extragenital symptoms, are fundamental aspects of the clinical diagnosis of DIE. The #ENZIAN classification, which correlates with the symptoms of the pathology, represents a reliable method for non-invasive multidisciplinary diagnosis of DIE and planning its surgical treatment within a multidisciplinary team of specialists.