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.
Prenatal Diagnosis Unit, The Edith Wolfson Medical Center, Holon and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. malinger@inter.net.il
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Malinger
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Levine
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Rotmensch
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*