Prenatal Ultrasonographic Findings of Esophageal Atresia: Potential Diagnostic Role of the Stomach Shape

Overview

Journal Obstet Gynecol Sci

Specialty Gynecology & Obstetrics

Date 2020 Dec 7

PMID 33285619

Citations 4

Authors

Chi-Son Chang

Yunsun Choi

Seo-Yeon Kim

Cheonga Yee

Mina Kim

Ji-Hee Sung

Sanghoon Lee

Suk-Joo Choi

Soo-Young Oh

Jeong-Meen Seo

Cheong-Rae Roh

Affiliations

Soon will be listed here.

Abstract

Objective: We investigated prenatal sonographic characteristics of esophageal atresia (EA) with advancing gestation. We focused on the degree of polyhydramnios and the stomach shape.

Methods: This study included 27 EA cases (EA group) and 81 idiopathic polyhydramnios cases (non-EA group). The non-EA group consisted of cases without any fetal structural anomaly, musculoskeletal disorder, chromosomal abnormality, or maternal diabetes. Both groups included only singleton pregnancies. Amniotic fluid index (AFI) and width/length (W/L) ratio as well as the product of width and length (W×L) of stomach were serially assessed during gestation and compared between the 2 groups. To predict EA using W/L ratio and W×L, receiver operating characteristic curve analysis was performed.

Results: Polyhydramnios was evident in 77.8% of EA cases. We observed 25.9% and 22.2% EA cases with an absent stomach and a small visible stomach, respectively. After 28 weeks, the EA group manifested significantly higher AFI than the non-EA group. After 32 weeks, W/L ratio in the EA group tended to be lower than that in the non-EA group (32-36 weeks: 1.36 vs. 1.72, P=0.092; >36 weeks: 1.43 vs. 1.63, P=0.024). To predict EA, the calculated area under the curve for W/L ratio was 0.651 after 32 weeks. The diagnosis of EA using a cut-off value of W/L ratio <1.376 showed sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio to be 84.6%, 52.9%, 1.796, and 0.081, respectively.

Conclusion: A low W/L ratio of stomach after 32 weeks with progressive idiopathic polyhydramnios may be used to predict EA.

Citing Articles

Polyhydramnios Secondary to Esophageal Atresia - Cervical Cerclage and Serial Amnioreduction to Prolong Gestational Age in Select Cases.

Baey S, Toh Q, Chiang L, Yeo G, Quek B, Laksmi N J Indian Assoc Pediatr Surg. 2024; 29(3):292-294.

PMID: 38912014 PMC: 11192265. DOI: 10.4103/jiaps.jiaps_259_23.

Prenatal ultrasonic diagnosis of esophageal atresia and tracheoesophageal fistula combined with interrupted inferior vena cava: a rare case report.

He Y, Song X, Cao Q, Sun H, Chang J, Zhang W J Ultrasound. 2024; .

PMID: 38904735 DOI: 10.1007/s40477-024-00879-8.

The Effect of Vanishing Twin on First- and Second-Trimester Maternal Serum Markers and Nuchal Translucency: A Multicenter Prospective Cohort Study.

Lee S, Han Y, Kim M, Shim J, Lee M, Oh S J Korean Med Sci. 2023; 38(38):e300.

PMID: 37750371 PMC: 10519777. DOI: 10.3346/jkms.2023.38.e300.

The effect of a vanishing twin on first- and second-trimester maternal serum markers and ultrasound screening for aneuploidy.

Lee D, Lee S, Lee S Obstet Gynecol Sci. 2023; 66(6):477-483.

PMID: 37532226 PMC: 10663394. DOI: 10.5468/ogs.22270.

References

Smith C, Plambeck R, Rayburn W, Albaugh K . Relation of mild idiopathic polyhydramnios to perinatal outcome. Obstet Gynecol. 1992; 79(3):387-9. DOI: 10.1097/00006250-199203000-00012. View

Deurloo J, Ekkelkamp S, Schoorl M, Heij H, Aronson D . Esophageal atresia: historical evolution of management and results in 371 patients. Ann Thorac Surg. 2002; 73(1):267-72. DOI: 10.1016/s0003-4975(01)03263-5. View

Ethun C, Fallon S, Cassady C, Mehollin-Ray A, Olutoye O, Zamora I . Fetal MRI improves diagnostic accuracy in patients referred to a fetal center for suspected esophageal atresia. J Pediatr Surg. 2014; 49(5):712-5. DOI: 10.1016/j.jpedsurg.2014.02.053. View

Kalache K, Wauer R, Mau H, Chaoui R, Bollmann R . Prognostic significance of the pouch sign in fetuses with prenatally diagnosed esophageal atresia. Am J Obstet Gynecol. 2000; 182(4):978-81. DOI: 10.1016/s0002-9378(00)70357-7. View

Bricker L, Garcia J, Henderson J, Mugford M, Neilson J, Roberts T . Ultrasound screening in pregnancy: a systematic review of the clinical effectiveness, cost-effectiveness and women's views. Health Technol Assess. 2000; 4(16):i-vi, 1-193. View

Yefet E, Daniel-Spiegel E . Outcomes From Polyhydramnios With Normal Ultrasound. Pediatrics. 2016; 137(2):e20151948. DOI: 10.1542/peds.2015-1948. View

Spaggiari E, Faure G, Rousseau V, Sonigo P, Millischer-Bellaiche A, Kermorvant-Duchemin E . Performance of prenatal diagnosis in esophageal atresia. Prenat Diagn. 2015; 35(9):888-93. DOI: 10.1002/pd.4630. View

Faure C, Righini Grunder F . Dysmotility in Esophageal Atresia: Pathophysiology, Characterization, and Treatment. Front Pediatr. 2017; 5:130. PMC: 5450509. DOI: 10.3389/fped.2017.00130. View

Stringer M, McKenna K, Goldstein R, Filly R, Adzick N, Harrison M . Prenatal diagnosis of esophageal atresia. J Pediatr Surg. 1995; 30(9):1258-63. DOI: 10.1016/0022-3468(95)90480-8. View

10.

Koivusalo A, Pakarinen M, Rintala R . Modern outcomes of oesophageal atresia: single centre experience over the last twenty years. J Pediatr Surg. 2013; 48(2):297-303. DOI: 10.1016/j.jpedsurg.2012.11.007. View

11.

Kunisaki S, Bruch S, Hirschl R, Mychaliska G, Treadwell M, Coran A . The diagnosis of fetal esophageal atresia and its implications on perinatal outcome. Pediatr Surg Int. 2014; 30(10):971-7. DOI: 10.1007/s00383-014-3562-2. View

12.

Felix J, Tibboel D, de Klein A . Chromosomal anomalies in the aetiology of oesophageal atresia and tracheo-oesophageal fistula. Eur J Med Genet. 2007; 50(3):163-75. DOI: 10.1016/j.ejmg.2006.12.004. View

13.

Sandlin A, Chauhan S, Magann E . Clinical relevance of sonographically estimated amniotic fluid volume: polyhydramnios. J Ultrasound Med. 2013; 32(5):851-63. DOI: 10.7863/ultra.32.5.851. View

14.

Lopez P, Keys C, Pierro A, Drake D, Kiely E, Curry J . Oesophageal atresia: improved outcome in high-risk groups?. J Pediatr Surg. 2006; 41(2):331-4. DOI: 10.1016/j.jpedsurg.2005.11.009. View

15.

Torfs C, Curry C, Bateson T . Population-based study of tracheoesophageal fistula and esophageal atresia. Teratology. 1995; 52(4):220-32. DOI: 10.1002/tera.1420520408. View

16.

Garabedian C, Sfeir R, Langlois C, Bonnard A, Khen-Dunlop N, Gelas T . Does prenatal diagnosis modify neonatal treatment and early outcome of children with esophageal atresia?. Am J Obstet Gynecol. 2014; 212(3):340.e1-7. DOI: 10.1016/j.ajog.2014.09.030. View

17.

Shulman A, Mazkereth R, Zalel Y, Kuint J, Lipitz S, Avigad I . Prenatal identification of esophageal atresia: the role of ultrasonography for evaluation of functional anatomy. Prenat Diagn. 2002; 22(8):669-74. DOI: 10.1002/pd.375. View

18.

Kalache K, Bamberg C, Proquitte H, Sarioglu N, Lebek H, Esser T . Three-dimensional multi-slice view: new prospects for evaluation of congenital anomalies in the fetus. J Ultrasound Med. 2006; 25(8):1041-9. DOI: 10.7863/jum.2006.25.8.1041. View

19.

Bradshaw C, Thakkar H, Knutzen L, Marsh R, Pacilli M, Impey L . Accuracy of prenatal detection of tracheoesophageal fistula and oesophageal atresia. J Pediatr Surg. 2016; 51(8):1268-72. DOI: 10.1016/j.jpedsurg.2016.02.001. View

20.

Muller C, Czerkiewicz I, Guimiot F, Dreux S, Salomon L, Khen-Dunlop N . Specific biochemical amniotic fluid pattern of fetal isolated esophageal atresia. Pediatr Res. 2013; 74(5):601-5. DOI: 10.1038/pr.2013.131. View