STUDY OBJECTIVE: To evaluate the sensitivity, specificity, negative predictive 
value, positive predictive value, association, and agreement of double-contrast 
barium enema (DCBE) and transrectal endoscopic ultrasonography (Tr EUS) in the 
diagnosis of rectosigmoid colon endometriosis.
DESIGN: Prospective nonrandomized (Canadian Task Force classification II-2).
SETTING: University hospital.
PATIENTS: We evaluated 37 patients with clinically suspected deeply infiltrating 
endometriosis (DIE) from January 2004 through January 2005.
INTERVENTIONS: Clinical examination, DCBE, Tr EUS, and laparoscopy for 
histologic confirmation.
MEASUREMENTS AND MAIN RESULTS: Deeply infiltrating endometriosis was confirmed 
by laparoscopic visualization and by histopathologic examination in all 
patients. Intestinal endometriosis was observed in 27 patients (72.9%). DCBE 
showed abnormalities suggestive of bowel endometriosis in 24 patients (64.9%) 
and Tr EUS in 28 patients (75.7%). Considering the DCBE findings we observed 
among the 24 abnormal examination results, 16 (42.3%) had spiculation, 16 
(42.3%) had circumferential narrowing of the bowel, and 4 (10.8%) had the mass 
effect sign. For DCBE the sensitivity was 88%, the specificity was 54%, the 
negative predictive value (NPV) was 70%, and the positive predictive value (PPV) 
was 78%. For Tr EUS the sensitivity, specificity, NPV, and PPV were 96%, 100%, 
90%, and 100%. A significant association of the DCBE and the Tr EUS in the 
diagnosis of intestinal DIE (p = .017) and a moderate agreement of the methods 
(kappa = 0.44) was also observed.
CONCLUSION: Our data, although limited by sample size, confirmed that DCBE has a 
good sensitivity and a low specificity in the diagnosis of intestinal DIE. The 
Tr EUS proved to have a higher sensitivity and specificity with elevated NPV and 
PPV. A significant association of the DCBE and the Tr EUS in the diagnosis of 
intestinal DIE and a moderate agreement of the methods was also observed.