RSS-Feed abonnieren
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0035-1558172
Measurement of Gastric Circumference in Foetuses with Oesophageal Atresia
Messung des Magenumfangs bei Feten mit ÖsophagusatresiePublikationsverlauf
received 18. Juli 2015
revised 23. August 2015
accepted 25. August 2015
Publikationsdatum:
14. Dezember 2015 (online)
![](https://www.thieme-connect.de/media/gebfra/201511/lookinside/thumbnails/10-1055-s-0035-1558172_gf971-1.jpg)
Abstract
Background: The specific recognition of oesophageal atresia (OA) with or without a tracheal fistula in a foetus is a diagnostic challenge for prenatal medicine. The aim of the present work is to analyse the value of the measurement of gastric size in the diagnosis of this significant malformation. Materials and Methods: Altogether, the examinations of 433 pregnancies between the 18.4 and 39.1 weeks of gestation were retrospectively analysed. 59 of these foetuses exhibited an OA. By means of a linear regression analysis with normal foetuses, significant parameters influencing gastric size were examined. Subsequently the gastric sizes were transformed into z values and a comparison was made between OA with and without fistulae with the help of t tests. Results: In the normal foetuses there was a significant association between the gastric circumference and the abdominal circumference (circumference = 6.809 + 0.179 × abdominal circumference, r = 0.686, p < 0.0001). In the normal group the average was 43.0 (standard deviation [SD] 13.7) mm and those in foetuses with and without fistuale were 33.8 (SD 22.7) and 0.9 (SD 3.7) mm. In 34 (57.6 %) foetuses with an OA, the gastric circumference was below the 5th percentile. In detail, there were 13 (34.2 %) foetuses with a fistula and 21 (100 %) without a fistula. The average z values in the normal group and in the groups of OA with fistula and without fistula amounted to 0.0 (SD 1.0), −1.3 (SD 2.2) and −4.5 (SD 1.0). Conclusion: Measurements of the gastric circumference below the 5th percentile should lead to further diagnostic measures, especially when associated with polyhydramnios. Although OA without a fistula is always conspicuous, only about one in three OAs with fistula are associated with a significantly smaller stomach.
Zusammenfassung
Fragestellung: Die gezielte Erkennung einer fetalen Ösophagusatresie (ÖA) mit oder ohne tracheale Fisteln stellt eine diagnostische Herausforderung für die Pränatalmedizin dar. Ziel der vorliegenden Arbeit war es, den Stellenwert der Messung des Magenumfangs für die Diagnostik dieser bedeutsamen Fehlbildung zu analysieren. Material und Methodik: Insgesamt wurden die Untersuchungen von 433 Schwangerschaften zwischen der 18,4 bis 39,1 Schwangerschaftswoche retrospektiv ausgewertet. 59 dieser Feten wiesen eine ÖA auf. Mittels linearer Regressionsanalyse wurden bei normalen Feten signifikante Einflussparameter auf den Magenumfang untersucht. Anschließend erfolgte die Umwandlung der Magenumfänge in z-Werte und der Vergleich zwischen den ÖA mit und ohne Fistel mit der Normalpopulation mithilfe eines t-Tests. Ergebnisse: Bei den normalen Feten zeigte sich eine signifikante Assoziation zwischen dem Umfang des Magens und dem Abdomenumfang (Umfang = 6,809 + 0,179 × Abdomenumfang, r = 0,686, p < 0,0001). Der mittlere Magenumfang lag in der normalen Gruppe bei 43,0 (Standardabweichung [STW] 13,7) mm und bei Feten mit und ohne Fistel bei 33,8 (STW 22,7) und 0,9 (STW 3,7) mm. Bei 34 (57,6 %) Feten mit einer ÖA lag der Magenumfang < 5er-Perzentile. Im Einzelnen waren es 13 (34,2 %) Feten mit einer Fistel und 21 (100 %) ohne Fistel. Die mittleren z-Werte in der normalen Gruppe und in der Gruppe der ÖA mit Fistel und ohne Fistel lagen bei 0,0 (STW 1,0), −1,3 (STW 2,2) und −4,5 (STW 1,0). Schlussfolgerung: Messungen des Magenumfangs < 5er-Perzentile sollten eine weiterführende Diagnostik nach sich ziehen. Während ÖA ohne Fisteln hierbei stets auffällig werden, weist nur ungefähr jede 3. ÖA mit Fistel einen signifikant verkleinerten Magen auf.
-
References
- 1 Pedersen RN, Calzolari E, Husby S et al. Oesophageal atresia: prevalence, prenatal diagnosis and associated anomalies in 23 European regions. Arch Dis Child 2012; 97: 227-232
- 2 Depaepe A, Dolk H, Lechat MF. The epidemiology of tracheo-oesophageal fistula and oesophageal atresia in Europe. EUROCAT Working Group. Arch Dis Child 1993; 68: 743-748
- 3 Forrester MB, Merz RD. Epidemiology of oesophageal atresia and tracheo-oesophageal fistula in Hawaii, 1986–2000. Public Health 2005; 119: 483-488
- 4 Abele H, Starz S, Hoopmann M et al. Idiopathic polyhydramnios and postnatal abnormalities. Fetal Diagn Ther 2012; 32: 251-255
- 5 de Jong EM, de Haan MA, Gischler SJ et al. Pre- and postnatal diagnosis and outcome of fetuses and neonates with esophageal atresia and tracheoesophageal fistula. Prenat Diagn 2010; 30: 274-279
- 6 Deurloo JA, Ekkelkamp S, Schoorl M et al. Esophageal atresia: Historical evolution of management and results in 371 patients. Ann Thorac Surg 2002; 73: 267-272
- 7 Konkin DE, Oʼhali WA, Webber EM et al. Outcomes in esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 2003; 38: 1726-1729
- 8 Lilja HE, Wester T. Outcome in neonates with esophageal atresia treated over the last 20 years. Pediatr Surg Int 2008; 24: 531-536
- 9 Little DC, Rescorla FJ, Grosfeld JL et al. Long-term analysis of children with esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 2003; 38: 852-856
- 10 Chetcuti P, Phelan PD. Gastrointestinal morbidity and growth after repair of oesophageal atresia and tracheo-oesophageal fistula. Arch Dis Child 1993; 68: 163-166
- 11 Chetcuti P, Phelan PD. Respiratory morbidity after repair of oesophageal atresia and tracheo-oesophageal fistula. Arch Dis Child 1993; 68: 167-170
- 12 Brantberg A, Blaas HG, Haugen SE et al. Esophageal obstruction-prenatal detection rate and outcome. Ultrasound Obstet Gynecol 2007; 30: 180-187
- 13 Kunisaki SM, Bruch SW, Hirschl RB et al. The diagnosis of fetal esophageal atresia and its implications on perinatal outcome. Pediatr Surg Int 2014; 30: 971-977
- 14 Garabedian C, Sfeir R, Langlois C et al. Does prenatal diagnosis modify neonatal treatment and early outcome of children with esophageal atresia?. Am J Obstet Gynecol 2015; 212: 340.e1-340.e7
- 15 Houben CH, Curry JI. Current status of prenatal diagnosis, operative management and outcome of esophageal atresia/tracheo-esophageal fistula. Prenat Diagn 2008; 28: 667-675
- 16 Sase M, Asada H, Okuda M et al. Fetal gastric size in normal and abnormal pregnancies. Ultrasound Obstet Gynecol 2002; 19: 467-470
- 17 Choudhry M, Boyd PA, Chamberlain PF et al. Prenatal diagnosis of tracheo-oesophageal fistula and oesophageal atresia. Prenat Diagn 2007; 27: 608-610
- 18 Stringer MD, McKenna KM, Goldstein RB et al. Prenatal diagnosis of esophageal atresia. J Pediatr Surg 1995; 30: 1258-1263
- 19 Ethun CG, Fallon SC, Cassady CI et al. Fetal MRI improves diagnostic accuracy in patients referred to a fetal center for suspected esophageal atresia. J Pediatr Surg 2014; 49: 712-715
- 20 Kalache KD, Wauer R, Mau H et al. Prognostic significance of the pouch sign in fetuses with prenatally diagnosed esophageal atresia. Am J Obstet Gynecol 2000; 182: 978-981
- 21 Yagel S, Sonigo P, Rousseau V et al. Esophageal atresia diagnosed with three-dimensional ultrasonography. Ultrasound Obstet Gynecol 2005; 26: 307-308
- 22 Solt I, Rotmensch S, Bronshtein M. The esophageal “pouch sign”: a benign transient finding. Prenat Diagn 2010; 30: 845-848
- 23 Brugger PC, Weber M, Prayer D. Magnetic resonance imaging of the normal fetal esophagus. Ultrasound Obstet Gynecol 2011; 38: 568-574
- 24 Malinger G, Levine A, Rotmensch S. The fetal esophagus: anatomical and physiological ultrasonographic characterization using a high-resolution linear transducer. Ultrasound Obstet Gynecol 2004; 24: 500-505
- 25 Develay-Morice J-E, Rathat G, Duyme M et al. Ultrasonography of fetal esophagus: healthy appearance and prenatal diagnosis of a case of esophagus atresia with esotracheal fistula. Gynecol Obstet Fertil 2007; 35: 249-257
- 26 Garabedian C, Verpillat P, Czerkiewicz I et al. Does a combination of ultrasound, MRI, and biochemical amniotic fluid analysis improve prenatal diagnosis of esophageal atresia?. Prenat Diagn 2014; 34: 839-842
- 27 Kusanovic JP, Nien JK, Gonçalves LF et al. The use of inversion mode and 3D manual segmentation in volume measurement of fetal fluid-filled structures: comparison with Virtual Organ Computer-aided AnaLysis (VOCAL). Ultrasound Obstet Gynecol 2008; 31: 177-186
- 28 Ioannou C, Sarris I, Salomon LJ et al. A review of fetal volumetry: the need for standardization and definitions in measurement methodology. Ultrasound Obstet Gynecol 2011; 38: 613-619
- 29 Czerkiewicz I, Dreux S, Beckmezian A et al. Biochemical amniotic fluid pattern for prenatal diagnosis of esophageal atresia. Pediatr Res 2011; 70: 199-202
- 30 Muller C, Czerkiewicz I, Guimiot F et al. Specific biochemical amniotic fluid pattern of fetal isolated esophageal atresia. Pediatr Res 2013; 74: 601-605
- 31 Sase M, Miwa I, Sumie M et al. Gastric emptying cycles in the human fetus. Am J Obstet Gynecol 2005; 193: 1000-1004