{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T12:30:10Z","timestamp":1788093010053,"version":"build-2803163510"},"reference-count":38,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,9,1]],"date-time":"2020-09-01T00:00:00Z","timestamp":1598918400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Deep infiltrating endometriosis (DIE) of the rectosigmoid is associated with painful symptoms. When medical treatment is ineffective, surgical resection remains the standard treatment, despite significant risk of adverse events. High\u2010intensity focused ultrasound (HIFU) is a minimally invasive ablative procedure. Focal\u2009One\u00ae is a transrectal HIFU (TR\u2010HIFU) device used in prostate cancer treatment. The primary objective of this study was to confirm the feasibility of treatment with TR\u2010HIFU in patients presenting with posterior DIE with rectosigmoid involvement. We also assessed its safety and clinical efficacy in this context.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a non\u2010controlled, prospective, Phase\u2010I clinical trial in a French University Hospital which is a multidisciplinary center for management of endometriosis. Included were patients older than 25\u2009years, without plans to conceive within 6\u2009months, who presented with a single lesion of posterior DIE, with rectosigmoid invasion, after failure of hormonal therapy. All lesions were assessed preoperatively using transvaginal sonography and magnetic resonance imaging. Patients completed questionnaires on gynecological and intestinal symptoms (similar to a visual analog scale (VAS)), and on quality of life (Medical Outcomes Study 36\u2010item short\u2010form survey (SF\u201036) and, for the second half of patients recruited, symptom scoring system for constipation (KESS), female sexual function index (FSFI) and endometriosis health profile short\u2010version score (EHP\u20105)), before, and at 1, 3 and 6\u2009months after, TR\u2010HIFU treatment with a Focal\u2009One real\u2010time ultrasound\u2010guided HIFU device.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010three consecutive\u00a0patients were included in the study between September 2015 and October 2019. All 23 lesions were visualized, giving a detection rate of 100%. Twenty lesions were treated (\u2018feasibility rate\u2019, 87.0%): in 13 the whole lesion was treated and in seven the lesion was treated partially. The mean duration of the TR\u2010HIFU procedure was 55.6\u2009min. We observed a significant improvement in VAS score at 6\u2009months, with differences relative to preoperative scores as follows, for: dysmenorrhea (\u20133.6, <jats:italic>P<\/jats:italic>\u2009=\u20090.004), dyspareunia (\u20132.4, <jats:italic>P<\/jats:italic>\u2009=\u20090.006), diarrhea (\u20133.0, <jats:italic>P<\/jats:italic>\u2009=\u20090.006), constipation (\u20133.0, <jats:italic>P<\/jats:italic>\u2009=\u20090.002), dyschezia (\u20133.2, <jats:italic>P<\/jats:italic>\u2009=\u20090.003), false urge to defecate (\u20133.3, <jats:italic>P<\/jats:italic>\u2009=\u20090.007), posterior pelvic pain (\u20133.8, <jats:italic>P<\/jats:italic>\u2009=\u20090.002) and asthenia (\u20133.8, <jats:italic>P<\/jats:italic>\u2009=\u20090.002). There was also a significant improvement in the SF\u201036 score, with an increase at 6\u2009months relative to the preoperative score in both the physical component summary (+\u20099.3%, <jats:italic>P<\/jats:italic>\u2009=\u20090.002) and mental component summary (+\u200910.9%, <jats:italic>P<\/jats:italic>\u2009=\u20090.017). No major complications occurred during or after any procedure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>TR\u2010HIFU therapy for posterior DIE is feasible. If its efficacy and safety are confirmed, it could be a minimally invasive alternative to surgery for the treatment of rectosigmoid endometriosis. \u00a9 2019 Authors. <jats:italic>Ultrasound in Obstetrics &amp; Gynecology<\/jats:italic> published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.21937","type":"journal-article","created":{"date-parts":[[2019,12,2]],"date-time":"2019-12-02T20:04:46Z","timestamp":1575317086000},"page":"431-442","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Transrectal high\u2010intensity focused ultrasound (<scp>HIFU<\/scp>) for management of rectosigmoid deep infiltrating endometriosis: results of <scp>Phase\u2010I<\/scp> clinical trial"],"prefix":"10.1002","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9847-2564","authenticated-orcid":false,"given":"C.\u2010A.","family":"Philip","sequence":"first","affiliation":[{"name":"Gynecology Department Croix\u2010Rousse University Hospital  Hospices Civils de Lyon, Lyon France"},{"name":"Claude Bernard Lyon 1 University, University of Lyon  Lyon France"},{"name":"LabTAU, INSERM (Unit 1032), Centre L\u00e9on B\u00e9rard, Lyon 1 University  F\u201069003 Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Warembourg","sequence":"additional","affiliation":[{"name":"Gynecology Department Croix\u2010Rousse University Hospital  Hospices Civils de Lyon, Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Dairien","sequence":"additional","affiliation":[{"name":"Gynecology Department Croix\u2010Rousse University Hospital  Hospices Civils de Lyon, Lyon France"},{"name":"Claude Bernard Lyon 1 University, University of Lyon  Lyon France"},{"name":"LabTAU, INSERM (Unit 1032), Centre L\u00e9on B\u00e9rard, Lyon 1 University  F\u201069003 Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Lefevre","sequence":"additional","affiliation":[{"name":"Gynecology Department Croix\u2010Rousse University Hospital  Hospices Civils de Lyon, Lyon France"},{"name":"Claude Bernard Lyon 1 University, University of Lyon  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Gelet","sequence":"additional","affiliation":[{"name":"LabTAU, INSERM (Unit 1032), Centre L\u00e9on B\u00e9rard, Lyon 1 University  F\u201069003 Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Chavrier","sequence":"additional","affiliation":[{"name":"Claude Bernard Lyon 1 University, University of Lyon  Lyon France"},{"name":"LabTAU, INSERM (Unit 1032), Centre L\u00e9on B\u00e9rard, Lyon 1 University  F\u201069003 Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Guillen","sequence":"additional","affiliation":[{"name":"EDAP\u2010TMS Company  Vaulx\u2010en\u2010Velin France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Tonoli","sequence":"additional","affiliation":[{"name":"EDAP\u2010TMS Company  Vaulx\u2010en\u2010Velin France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Maissiat","sequence":"additional","affiliation":[{"name":"Radiology Department Croix\u2010Rousse University Hospital  Hospices Civils de Lyon, Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Lafon","sequence":"additional","affiliation":[{"name":"Claude Bernard Lyon 1 University, University of Lyon  Lyon France"},{"name":"LabTAU, INSERM (Unit 1032), Centre L\u00e9on B\u00e9rard, Lyon 1 University  F\u201069003 Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Dubernard","sequence":"additional","affiliation":[{"name":"Gynecology Department Croix\u2010Rousse University Hospital  Hospices Civils de Lyon, Lyon France"},{"name":"Claude Bernard Lyon 1 University, University of Lyon  Lyon France"},{"name":"LabTAU, INSERM (Unit 1032), Centre L\u00e9on B\u00e9rard, Lyon 1 University  F\u201069003 Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,9]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199306173282407"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deq017"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ogx.0000268688.55653.5c"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deg009"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogoh.2016.09.004"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2017.09.006"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2010.11.011"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2007.10.009"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1085\/jgp.26.2.179"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1259\/bjr\/17150274"},{"key":"e_1_2_7_12_1","first-page":"1428","article-title":"Treatment by HIFU of prostate cancer: survey of literature and treatment indications","volume":"13","author":"Rebillard X","year":"2003","journal-title":"Prog Urol"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.3109\/02656736.2010.498803"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000007687"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.14366\/usg.16040"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14741"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14737"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-017-4548-9"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogoh.2018.06.003"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-016-4673-z"},{"key":"e_1_2_7_21_1","unstructured":"National Institute for Health and Care Excellence (NICE).Endometriosis: diagnosis and management. NICE Guideline [NG73] 2017.https:\/\/www.nice.org.uk\/guidance\/ng73\/resources\/endometriosis\u2010diagnosis\u2010and\u2010management\u2010pdf\u20101837632548293OR perhaps:https:\/\/www.nice.org.uk\/guidance\/ng73"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2015.02.006"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2008.09.005"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2017.01.152"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmu046"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/den026"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(94)00227-H"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-4356(98)00093-6"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-008-9403-9"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1080\/00926230590475206"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1023\/B:QURE.0000021321.48041.0e"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02236639"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1121\/1.429476"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gyobfe.2007.08.002"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181b13ca2"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2010.06.037"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.14751"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2013.04.039"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2016.02.054"}],"container-title":["Ultrasound in Obstetrics &amp; Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.21937","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/uog.21937","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.21937","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T09:44:25Z","timestamp":1693302265000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.21937"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9]]},"references-count":38,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2020,9]]}},"alternative-id":["10.1002\/uog.21937"],"URL":"https:\/\/doi.org\/10.1002\/uog.21937","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9]]},"assertion":[{"value":"2019-08-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-11-14","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-09-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}