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

INTRODUCTION: 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. MATERIAL AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.