Obstet Gynecol Sci.  2021 Jan;64(1):42-51. 10.5468/ogs.20207.

Prenatal ultrasonographic findings of esophageal atresia: potential diagnostic role of the stomach shape

• Chang CS
• Choi Y
• Kim Sy
• Yee C
• Kim M
• Sung JH
• Lee S
• Choi SJ
• Oh Sy
• Seo JM
• Roh CR

• KMID: 2511564
• DOI: http://doi.org/10.5468/ogs.20207

Abstract

Objective
We investigated prenatal sonographic characteristics of esophageal atresia (EA) with advancing gestation. We focused on the degree of polyhydramnios and the stomach shape.
Methods
This study included 27 EA cases (EA group) and 81 idiopathic polyhydramnios cases (non-EA group). The non-EA group consisted of cases without any fetal structural anomaly, musculoskeletal disorder, chromosomal abnormality, or maternal diabetes. Both groups included only singleton pregnancies. Amniotic fluid index (AFI) and width/length (W/L) ratio as well as the product of width and length (W×L) of stomach were serially assessed during gestation and compared between the 2 groups. To predict EA using W/L ratio and W×L, receiver operating characteristic curve analysis was performed.
Results
Polyhydramnios was evident in 77.8% of EA cases. We observed 25.9% and 22.2% EA cases with an absent stomach and a small visible stomach, respectively. After 28 weeks, the EA group manifested significantly higher AFI than the non-EA group. After 32 weeks, W/L ratio in the EA group tended to be lower than that in the non-EA group (32–36 weeks: 1.36 vs. 1.72, P=0.092; >36 weeks: 1.43 vs. 1.63, P=0.024). To predict EA, the calculated area under the curve for W/L ratio was 0.651 after 32 weeks. The diagnosis of EA using a cut-off value of W/L ratio <1.376 showed sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio to be 84.6%, 52.9%, 1.796, and 0.081, respectively.
Conclusion
A low W/L ratio of stomach after 32 weeks with progressive idiopathic polyhydramnios may be used to predict EA.

Keyword

Esophageal atresia; Stomach shape; Polyhydramnios; Ultrasound; Prenatal diagnosis

Figure

• 

  Fig. 1 Transverse plane of the fetal abdomen for measuring abdominal circumference. To determine the difference in stomach shape between esophageal atresia (EA) and non-EA cases in the presence of polyhydramnios, we calculated the width/length ratio of the stomach by measuring the width and length of the stomach from this view. The stomach of a normal fetus with idiopathic polyhydramnios (a) and the stomach of a fetus with EA (b).

• 

  Fig. 2 (a) Mean plot and Box plot showing the trend of amniotic fluid index (AFI) with advancing gestation in the esophageal atresia (EA) and non-EA groups (P=0.008). (b) Mean plot and Box plot showing the trend of stomach width/length (W/L) ratio with advancing gestation in the EA and non-EA groups (P=0.212). (C) Mean plot and Box plot showing the trend of the product of width and length (W×L) of stomach with advancing gestation in the EA and non-EA groups (P=0.010).

• 

  Fig. 3 (A) Receiver operating characteristic (ROC) curve with area under the curve (AUC) for stomach width/length (W/L) ratio after 32 weeks and 36 weeks of gestational age (GA) for the suspicion of esophageal atresia (EA). After 32 weeks: Cut-off value <1.376, AUC=0.651 (95% confidence interval [CI], 0.492–0.810; P=0.052). Sensitivity 0.846, specificity 0.529, positive likelihood ratio (LR+) 1.796, negative likelihood ratio (LR−) 0.081. After 36 weeks: Cut-off value <1.470, AUC=0.722 (95% CI, 0.533–0.912; P=0.024). Sensitivity 0.761, specificity 0.700, LR+ 2.537, LR− 0.341. (B) ROC curve with AUC for the product of width and length (W×L) of stomach after 28 weeks of GA for the suspicion of EA. Cut-off value <1.674, AUC=0.880 (95% CI, 0.761–0.999; P<0.001). Sensitivity 0.938, specificity 0.850, LR+ 6.253, LR− 0.073.

Reference

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