@article {Weissbach206, author = {Tal Weissbach and Anya Kushnir and Ella Haber Kaptsenel and Leah Leibovitch and Ron Bilik and Daniel Shinhar and Gideon Karplus and Reuven Achiron and Zvi Kivilevitch and Eran Barzilay and Shali Mazaki Tovi and Boaz Weisz and Eran Kassif}, title = {Oesophageal atresia: sonographic signs may prenatally predict surgical complexity}, volume = {107}, number = {2}, pages = {206--210}, year = {2022}, doi = {10.1136/archdischild-2021-321836}, publisher = {BMJ Publishing Group}, 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 repairMethods 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.All data relevant to the study are included in the article or uploaded as supplementary information.}, issn = {1359-2998}, URL = {https://fn.bmj.com/content/107/2/206}, eprint = {https://fn.bmj.com/content/107/2/206.full.pdf}, journal = {Archives of Disease in Childhood - Fetal and Neonatal Edition} }