The fetal esophagus: anatomical and physiological ultrasonographic characterization using a high-resolution linear transducer.
OBJECTIVE
To study the sonographic anatomy and physiology of the human fetal esophagus during the mid-trimester of pregnancy using a high-resolution linear transducer.


METHODS
This was a prospective observational study of the fetal esophagus between 19 and 25 weeks' gestation. The study was performed in 60 consecutive fetuses, after a normal anatomy scan, using a 5-13-MHz matrix array wide-band transducer. During the examination the collapsed esophagus was first visualized, and followed by a 5-min video recording in order to demonstrate luminal patency and peristaltic waves.


RESULTS
Complete anatomical visualization of the esophagus was possible in 52 (86.7%) patients and at least partial visualization in 58 (96.7%) patients. Three different patterns of esophageal motility were observed: a simultaneous and short opening of the whole esophagus was found in 35 (58.3%) fetuses; a segmental, peristalsis-like movement from the pharynx, through the mediastinum, and into the stomach was found in 18 (30%) fetuses; and in one fetus reflux-like passage of solid contents from the stomach was observed. The mean time required for demonstration of esophageal patency was 96.1 (range, 10-300) s.


CONCLUSIONS
Demonstration of normal anatomy and physiological activity of the fetal esophagus is feasible using appropriate transducers. The most commonly observed pattern of esophageal motility in the mid-trimester of pregnancy is the simultaneous relaxation of the upper and lower esophageal sphincters with concurrent opening of the esophageal lumen from the upper thorax to the stomach. Demonstration of a patent esophagus may be helpful in fetuses with suspected esophageal atresia.
Malinger
G
G
Prenatal Diagnosis Unit, The Edith Wolfson Medical Center, Holon and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. malinger@inter.net.il
Levine
A
A
Rotmensch
S
S
D004947:Esophagus / Q000000981:diagnostic imaging / Q000196:embryology*; D005260:Female; D005769:Gastrointestinal Motility / Q000502:physiology; D005865:Gestational Age; D006801:Humans; D007089:Image Enhancement / Q000295:instrumentation; D011247:Pregnancy; D011446:Prospective Studies; D014159:Transducers; D016216:Ultrasonography, Prenatal / Q000295:instrumentation*