Looking ahead: new approaches to the diagnosis, treatment, and rehabilitation of patients with deep infiltrating endometriosis

Deep infiltrating endometriosis (DIE) is a severe form of endometriosis characterized by deep infiltration of endometriotic tissue into the retroperitoneal space and muscular walls of pelvic organs. Its nonspecific clinical presentation and the limited sensitivity of standard diagnostic methods contribute to significant diagnostic delays, while current treatments are primarily symptomatic and associated with high recurrence rates. This review summarizes current and emerging approaches to the diagnosis of DIE, including molecular markers, high-resolution imaging techniques, standardized protocols and classifications, and artificial intelligence-based algorithms. Potential therapeutic targets involved in the pathogenesis of DIE are discussed, including the PI3K/Akt/mTOR signaling pathway, microRNAs, fibrogenic factors, and specific immune mechanisms. Particular attention is given to multidisciplinary rehabilitation strategies, such as physiotherapy, exercise, nutritional and psychological support, and modulation of the vaginal and gut microbiota. Further advances in the diagnosis, treatment, and rehabilitation of patients with DIE are needed to facilitate earlier diagnosis, enable personalized therapy, and improve long-term clinical outcomes.