Current status of prenatal diagnosis, operative management and outcome of esophageal atresia/tracheo-esophageal fistula.
Ultrasonographic features suggestive of esophageal atresia with or without tracheo-esophageal fistula (EA/TEF) are only in a small minority of fetuses with EA/TEF (<10%) identifiable on prenatal scans.The prenatal diagnosis of EA/TEF relies in principle, on two nonspecific signs: polyhydramnios and absent or small stomach bubble. Polyhydramnios is associated with a wide range of fetal abnormalities, but most commonly it pursues a benign course. Similarly the sonographic absence of a stomach bubble may point to a variety of fetal anomalies.The combination of polyhydramnios and absent stomach bubble in two small series offers a modest positive predictive value of 44 and 56% respectively. Prenatal scanning for EA/TEF identifies a larger proportion of fetuses with Edwards syndrome; there is also a higher proportion of isolated EA in comparison to postnatal studies.Current ultrasound technology does not allow for a definite diagnosis of EA/TEF and therefore, counseling of parents should be guarded.Postnatal diagnosis of EA is confirmed by the failure to pass a firm nasogastric tube into the stomach; on chest X-ray, the tube is seen curling in the upper esophageal pouch. Corrective surgery for EA/TEF is well established and survival rates of over 90% can be expected.
Houben
C H
CH
Department of Paediatric Surgery, Hospitals for Sick Children, Great Ormond Street, London WC1N 3JH, UK.
Curry
J I
JI
D013505:Digestive System Surgical Procedures; D004933:Esophageal Atresia / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D006831:Polyhydramnios / Q000000981:diagnostic imaging / Q000209:etiology; D011247:Pregnancy; D014138:Tracheoesophageal Fistula / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D016216:Ultrasonography, Prenatal