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Current status of prenatal diagnosis, operative management and outcome of esophageal atresia/tracheo‐esophageal fistula

2008; Wiley; Volume: 28; Issue: 7 Linguagem: Inglês

10.1002/pd.1938

1097-0223

Christoph H. Houben, J. Curry,

Congenital Diaphragmatic Hernia Studies

Abstract 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. Copyright © 2008 John Wiley & Sons, Ltd.