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Oesophageal atresia: sonographic signs may prenatally predict surgical complexity
  1. Tal Weissbach1,2,
  2. Anya Kushnir2,3,
  3. Ella Haber Kaptsenel2,
  4. Leah Leibovitch2,4,
  5. Ron Bilik2,5,
  6. Daniel Shinhar2,5,
  7. Gideon Karplus2,5,
  8. Reuven Achiron1,2,
  9. Zvi Kivilevitch6,
  10. Eran Barzilay7,
  11. Shali Mazaki Tovi1,2,
  12. Boaz Weisz1,2,
  13. Eran Kassif1,2
  1. 1 Obstetrics and Gynecology, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel
  2. 2 Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
  3. 3 Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
  4. 4 Neonatology, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel
  5. 5 Pediatric Surgery, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel
  6. 6 Women's Ultrasound Unit, Maccabi Health Services, Beer Sheva, Israel
  7. 7 Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
  1. Correspondence to Dr Tal Weissbach, Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer 5266202, Israel; ferbyt{at}gmail.com

Abstract

Objective Oesophageal atresia (OA) is a major anomaly of varying severity. The complexity of surgical correction highly depends on the gap length of missing oesophagus and the presence of a distal fistula. The aim of this study was to identify antenatal sonographic findings associated with presence of a distal fistula and type of surgical repair

Methods Prenatal medical records of neonates postnatally diagnosed with OA were reviewed. Sonographic signs of OA (small/absent stomach, polyhydramnios, oesophageal pouch) and the trimester at sign detection were recorded and compared between (1) OA with and without a distal fistula and (2) early one-step versus delayed two-step anastomosis. Multivariate analysis was performed.

Results Overall, 80 cases of OA were included. Absence of a distal fistula was significantly associated with higher rates of small/absent stomach (100% vs 28.6%, P<0.0001), oesophageal pouch (100% vs 24.3%, P<0.0001) and severe polyhydramnios (66.7% vs 22.9%, P=0.006), compared with OA with a distal fistula.

Cases requiring a delayed two-step repair had higher rates of small/absent stomach (84.2% vs 16.7%, P>0.0001), severe polyhydramnios (47.4% vs 16.7%, P=0.008) and oesophageal pouch (73.7% vs 18.5%, P<0.0001), compared with those corrected in an early one-step anastomosis.

Multivariate logistic regression found small/absent stomach and pouch to be significantly and independently associated with a delayed two-step anastomosis.

Conclusion OA without a distal fistula is associated with higher rates of prenatal sonographic signs. Both small/absent stomach and a pouch are independently associated with a delayed two-step anastomosis. These findings may help improve antenatal parental counselling regarding the anticipated surgical repair.

  • gastroenterology
  • neonatology

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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