Diagnostic accuracy of sliding sign for detecting pouch of Douglas obliteration and bowel involvement in women with suspected endometriosis: systematic review and meta-analysis

Objective: The aim of this meta-analysis is to evaluate the diagnostic accuracy of the sliding sign in transvaginal ultrasound (TVS) to detect pouch of Douglas obliteration (PoDo) and bowel involvement (BI) in patients with suspected endometriosis, using laparoscopy as the reference standard.

Methods: A search for studies evaluating the role of sliding sign for assessing PoDo and bowel involvement compared to surgery from January 2000 to October 2021 was performed in PubMed/MEDLINE, Web of Science, CINAHL, Cochrane, Clinicaltrial.gov and Scopus databases. The Quality Assessment of Diagnostic Accuracy Studies 2 evaluated the quality of the studies (QUADAS-2). All analyses were performed using MIDAS and METANDI commands.

Results: We identified 334 citations. After exclusions, eight studies comprising 938 (PoDo) and 963 (BI) women were included. Mean prevalence of PoDo was 37%. Mean prevalence of bowel involvement was 23%. The pooled estimated sensitivity, specificity, positive likelihood, negative likelihood ratio and diagnostic odd ratio of sliding sign in TVS for detecting PoDo were 88% (95% confidence interval [CI]=81%-93%), 94% (95% CI=91%-96%), 15.1 (95% CI=10.0-22.8), 0.12 (95% CI= 0.07-0.21) and 124 (95% CI=62-245)., respectively.

Heterogeneity was moderate. The pooled estimated sensitivity, specificity, positive likelihood, negative likelihood ratio and diagnostic odd ratio of sliding sign in TVS for detecting bowel involvement were 81% (95% confidence interval [CI]=64%-91%), 95% (95% CI=91%-97%), 16.0 (95% CI= 9.0-28.6), 0.20 (95% CI= 0.10-0.40) and 81 (95% CI=34-191)., respectively. Heterogeneity was moderate for both cases.

Conclusions: The sliding sign in TVS has good diagnostic performance for predicting pouch of Douglas obliteration and bowel involvement in women with suspected endometriosis. This article is protected by copyright. All rights reserved.

CITA DEL ARTÍCULO  Ultrasound Obstet Gynecol. 2022 Oct;60(4):477-486. doi: 10.1002/uog.24900. Epub 2022 Sep 12.