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Human Reproduction, Vol. 10, No. 4, pp. 923-926, 1995
© 1995 European Society of Human Reproduction and Embryology

research-article

Endometriosis: The bubble test: a new tool to improve the diagnosis of endometriosis*

Norbert Gleicher1, Vishvanath Karande, Douglas Rabin, Alan Dudkiewicz and Donna Pratt

The Center for Human Reproduction and The Foundation for Reproductive Medicine Inc. Chicago, IL 60610, USA

Correspondence: 1To whom correspondence should be addressed at: The Center for Human Reproduction, 750 New Orleans Street, Chicago, IL 60610, USA

The objective of this study was to determine the clinical sensitivity and specificity of a bubbling phenomenon, including peritoneal surfaces, as a diagnostic test for endometriosis during laparoscopy. A prospectively controlled study of women with infertility of at least 1 year duration, who underwent laparoscopy, was conducted at a medical school-affiliated private infertility centre and research foundation. The study included 48 prospectively enrolled female infertility patients who underwent laparoscopy. Of these, 32 were found to suffer from endometriosis (group A) and 16 control patients did not show any evidence of disease (group B). The study involved the irrigation of the posterior cul-de-sac with short bursts of either saline or lactated Ringer‘s solution, utilizing a standard laparoscopic aspiration/irrigation system, and the subsequent observation for an excessive soap-like bubbling phenomenon (positive bubble test) in association with endometriosis. All 32 endometriosis patients (group A) demonstrated a positive bubble test. In contrast, only two of the 16 control patients (group B) were positive (P = 0.00242, Fisher's exact test; odds ratio, 8.000). A positive bubble test during laparoscopy was thus 100% sensitive and 88% specific for the diagnosis of endometriosis by laparoscopy, resulting in positive and negative predictive values of 94 and 100% respectively. Since the literature provides considerable evidence that the diagnosis of endometriosis during laparoscopy is frequently missed, a positive bubble test during laparoscopy therefore may be considered a reason to search further (possibly with biopsies) for endometriosis in the absence of obviously visible disease. If confirmed, a positive bubble test could then become an even more accurate single diagnostic test for endometriosis than laparoscopy.

Key words: diagnosis/endometriosis/tests

*Presented in part in the form of an audio-visual presentation at the Annual Meeting of The American Fertility Society, Montreal, Canada, October 11, 1993.


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