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Sfeir R, Aumar M, Sharma D, Labreuche J, Dauchet L, Gottrand F. The French Experience with a Population-Based Esophageal Atresia Registry (RENATO). Eur J Pediatr Surg 2024; 34:137-142. [PMID: 37940126 DOI: 10.1055/a-2206-6837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
This paper presented a national register for esophageal atresia (EA) started in January 2008. We report our experience about the conception of this database and its coordination. Data management and data quality are also detailed. In 2023, more than 2,500 patients with EA are included. Prevalence of EA in France was calculated at 1.8/10,000 live birth. Main clinical results are listed with scientific publications issued directly from the register.
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Affiliation(s)
- Rony Sfeir
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Reference Center for Congenital and Malformative Esophageal Disorders, Jeanne de Flandre Children's Hospital, Lille University Faculty of Medicine, Lille Cedex, Lille, France
| | - Madeleine Aumar
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Reference Center for Congenital and Malformative Esophageal Disorders, Jeanne de Flandre Children's Hospital, Lille University Faculty of Medicine, Lille Cedex, Lille, France
| | - Dyuti Sharma
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Reference Center for Congenital and Malformative Esophageal Disorders, Jeanne de Flandre Children's Hospital, Lille University Faculty of Medicine, Lille Cedex, Lille, France
| | - Julien Labreuche
- SEED: Statistique, Evaluation, Economique, Data-Management Maison Régionale de la Recherche Clinique University Hospital of Lille, France - Health Statistics, Lille, France
| | - Luc Dauchet
- Department of Epidemiology and Public Health, University Hospital of Lille, France - Public Health, Lille, France
| | - Frederic Gottrand
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Reference Center for Congenital and Malformative Esophageal Disorders, Jeanne de Flandre Children's Hospital, Lille University Faculty of Medicine, Lille Cedex, Lille, France
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2
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Weissbach T, Kushnir A, Yousefi S, Massarwa A, Leibovitch L, Frank DD, Kidron D, Achiron R, Meyer R, Weisz B, Mazaki Tovi S, Kassif E. The prenatal detection of distal tracheoesophageal fistulas in fetuses diagnosed with esophageal atresia. Am J Obstet Gynecol 2022; 227:897.e1-897.e9. [PMID: 35940225 DOI: 10.1016/j.ajog.2022.06.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Esophageal atresia is a major anomaly of varying severity. The complexity of surgical correction depends on the presence of a distal fistula. OBJECTIVE This study aimed to determine the feasibility and accuracy of prenatal ultrasound detection of the distal fistula in fetuses diagnosed with esophageal atresia. STUDY DESIGN This was an observational study conducted at a single tertiary care center between 2019 and 2021. Included were pregnant patients carrying a fetus prenatally diagnosed with esophageal atresia that was confirmed postnatally during corrective surgery or at postmortem autopsy. During the scan, the performing investigator determined the presence or absence of a distal fistula by scanning the location of the lower esophagus during fetal breathing. Cases in which the lower esophagus was observed distending with amniotic fluid during breathing were deemed "fistula present," and the remaining cases "fistula absent." Test feasibility and performance indices, including sensitivity, specificity, and positive and negative predictive value were calculated. The offline clips and images were reviewed by 2 investigators for the assessment of interoperator agreement using Cohen's Kappa formula. RESULTS Included were 16 fetuses with esophageal atresia scanned between 2019 and 2021. All fetuses were successfully scanned with sufficient resolution of the area of interest during at least 3 cycles of breathing. It took a median of 8.5 minutes to determine the presence or absence of a distal fistula. The feasibility of the test was 100% (16/16). The test's sensitivity, specificity, and positive and negative predictive values were 80% (95% confidence interval, 55-100), 100% (95% confidence interval, 60-100), 100% (95% confidence interval, 65-100), and 75% (95% confidence interval, 45-100), respectively. The Cohen's Kappa for interoperator agreement was calculated to be 1, P<.001, corresponding to a "perfect" level of agreement. CONCLUSION Distal fistulas in esophageal atresia can be demonstrated prenatally by targeted scanning using appropriate technique. The method provided is feasible, reproducible, and has excellent performance indices. This novel technique and observations may improve the prenatal diagnosis and counseling of esophageal atresia.
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Affiliation(s)
- Tal Weissbach
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel.
| | - Anya Kushnir
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Shayan Yousefi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Abeer Massarwa
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Leah Leibovitch
- Department of Neonatology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Denise-Dana Frank
- Department of Pathology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Debora Kidron
- Department of Pathology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Reuven Achiron
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Raanan Meyer
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Boaz Weisz
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Shali Mazaki Tovi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Eran Kassif
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel
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3
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Weissbach T, Kushnir A, Haber Kaptsenel E, Leibovitch L, Bilik R, Shinhar D, Karplus G, Achiron R, Kivilevitch Z, Barzilay E, Mazaki Tovi S, Weisz B, Kassif E. Oesophageal atresia: sonographic signs may prenatally predict surgical complexity. Arch Dis Child Fetal Neonatal Ed 2022; 107:206-210. [PMID: 34321245 DOI: 10.1136/archdischild-2021-321836] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/09/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Oesophageal atresia (OA) is a major anomaly of varying severity. The complexity of surgical correction highly depends on the gap length of missing oesophagus and the presence of a distal fistula. The aim of this study was to identify antenatal sonographic findings associated with presence of a distal fistula and type of surgical repair METHODS: Prenatal medical records of neonates postnatally diagnosed with OA were reviewed. Sonographic signs of OA (small/absent stomach, polyhydramnios, oesophageal pouch) and the trimester at sign detection were recorded and compared between (1) OA with and without a distal fistula and (2) early one-step versus delayed two-step anastomosis. Multivariate analysis was performed. RESULTS Overall, 80 cases of OA were included. Absence of a distal fistula was significantly associated with higher rates of small/absent stomach (100% vs 28.6%, P<0.0001), oesophageal pouch (100% vs 24.3%, P<0.0001) and severe polyhydramnios (66.7% vs 22.9%, P=0.006), compared with OA with a distal fistula.Cases requiring a delayed two-step repair had higher rates of small/absent stomach (84.2% vs 16.7%, P>0.0001), severe polyhydramnios (47.4% vs 16.7%, P=0.008) and oesophageal pouch (73.7% vs 18.5%, P<0.0001), compared with those corrected in an early one-step anastomosis.Multivariate logistic regression found small/absent stomach and pouch to be significantly and independently associated with a delayed two-step anastomosis. CONCLUSION OA without a distal fistula is associated with higher rates of prenatal sonographic signs. Both small/absent stomach and a pouch are independently associated with a delayed two-step anastomosis. These findings may help improve antenatal parental counselling regarding the anticipated surgical repair.
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Affiliation(s)
- Tal Weissbach
- Obstetrics and Gynecology, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel .,Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Anya Kushnir
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.,Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Leah Leibovitch
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.,Neonatology, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel
| | - Ron Bilik
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.,Pediatric Surgery, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel
| | - Daniel Shinhar
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.,Pediatric Surgery, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel
| | - Gideon Karplus
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.,Pediatric Surgery, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel
| | - Reuven Achiron
- Obstetrics and Gynecology, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel.,Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Zvi Kivilevitch
- Women's Ultrasound Unit, Maccabi Health Services, Beer Sheva, Israel
| | - Eran Barzilay
- Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Shali Mazaki Tovi
- Obstetrics and Gynecology, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel.,Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Boaz Weisz
- Obstetrics and Gynecology, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel.,Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Eran Kassif
- Obstetrics and Gynecology, Sheba Medical Center at Tel HaShomer, Tel HaShomer, Israel.,Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
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4
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Kassif E, Elkan Miller T, Tsur A, Trozky Y, Gur T, De Castro H, Hadi E, Yulzari V, Weissmann-Brenner A, Messing B, Yoeli-Ullman R, Sharon R, Mazaki-Tovi S, Achiron R, Weisz B, Weissbach T. Dynamic esophageal patency assessment: an effective method for prenatally diagnosing esophageal atresia. Am J Obstet Gynecol 2021; 225:674.e1-674.e12. [PMID: 34146530 DOI: 10.1016/j.ajog.2021.06.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Esophageal atresia is a major anomaly with a low prenatal detection rate. We propose a sonographic method termed dynamic esophageal patency assessment. OBJECTIVE This study aimed to assess the feasibility and performance of the dynamic esophageal patency assessment in a high-risk population. STUDY DESIGN A prospective study was conducted in a single tertiary fetal ultrasound unit for 12 months. The study group included pregnant women referred for a targeted scan because of one or more of the following: (1) polyhydramnios; (2) small or absent stomach; (3) vertebral, anal atresia, cardiac, tracheoesophageal fistula, renal, and limb abnormalities; (4) first-degree relative with esophageal atresia; and (5) genetic mutation associated with esophageal atresia. In addition to dynamic esophageal patency assessment, a comprehensive anomaly scan was carried out. The fetal esophagus was observed during swallowing. Cases that demonstrated uninterrupted fluid propagation through the esophagus were classified as normal. Cases that demonstrated interrupted fluid propagation, with the formation of a pouch, were classified as abnormal. Cases with unclear visualization of the esophagus or cases that failed to demonstrate either fluid propagation or a pouch were classified as undetermined. Dynamic esophageal patency assessment results were compared with postnatal findings, considered "gold standard." Test performance indices and intra- and interobserver agreements were calculated. RESULTS For 12 months, 130 patients were recruited, and 132 fetuses were scanned. The median gestational age (interquartile range) at the time of scan was 31.4 weeks (29.0-35.3). Of 132 fetuses enrolled, 123 (93.2%) were normal, 8 (6%) were abnormal, and 1 (0.8%) was undetermined. Excluded from test performance analysis were 3 cases that were terminated without postmortem autopsy (1 was abnormal and 2 were normal), and a fourth case was excluded as it was classified as undetermined. The detection rate of esophageal atresia was 100%, with no false-positive or false-negative case. Sensitivity, specificity, and positive and negative predictive values of the dynamic esophageal patency assessment were 100%. The Kappa coefficient was 1 for both inter- and intraobserver agreements (P<.0001). The median time (interquartile range) required to complete the dynamic esophageal patency assessment was 6.00 minutes (3.00-13.25). CONCLUSION The dynamic esophageal patency assessment is a feasible and highly effective method of ascertaining an intact esophagus and detecting esophageal atresia in suspected cases.
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Lejeune S, Sfeir R, Rousseau V, Bonnard A, Gelas T, Aumar M, Panait N, Rabattu PY, Irtan S, Fouquet V, Le Mandat A, Cocci SDN, Habonimana E, Lamireau T, Lemelle JL, Elbaz F, Talon I, Boudaoud N, Allal H, Buisson P, Petit T, Sapin E, Lardy H, Schmitt F, Levard G, Scalabre A, Michel JL, Jaby O, Pelatan C, De Vries P, Borderon C, Fourcade L, Breaud J, Arnould M, Tolg C, Chaussy Y, Geiss S, Laplace C, Drumez E, El Mourad S, Thumerelle C, Gottrand F. Esophageal Atresia and Respiratory Morbidity. Pediatrics 2021; 148:peds.2020-049778. [PMID: 34413249 DOI: 10.1542/peds.2020-049778] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Respiratory diseases are common in children with esophageal atresia (EA), leading to increased morbidity and mortality in the first year. The primary study objective was to identify the factors associated with readmissions for respiratory causes in the first year in EA children. METHODS A population-based study. We included all children born between 2008 and 2016 with available data and analyzed factors at birth and 1 year follow-up. Factors with a P value <.10 in univariate analyses were retained in logistic regression models. RESULTS Among 1460 patients born with EA, 97 (7%) were deceased before the age of 1 year, and follow-up data were available for 1287 patients, who constituted our study population. EAs were Ladd classification type III or IV in 89%, preterm birth was observed in 38%, and associated malformations were observed in 52%. Collectively, 61% were readmitted after initial discharge in the first year, 31% for a respiratory cause. Among these, respiratory infections occurred in 64%, and 35% received a respiratory treatment. In logistic regression models, factors associated with readmission for a respiratory cause were recurrence of tracheoesophageal fistula, aortopexy, antireflux surgery, and tube feeding; factors associated with respiratory treatment were male sex and laryngeal cleft. CONCLUSIONS Respiratory morbidity in the first year after EA repair is frequent, accounting for >50% of readmissions. Identifying high risk groups of EA patients (ie, those with chronic aspiration, anomalies of the respiratory tract, and need for tube feeding) may guide follow-up strategies.
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Affiliation(s)
- Stéphanie Lejeune
- Reference Center for Chronic Esophageal Anomalies, Reference Center for Rare Esophageal Diseases, INFINITE Lille
| | - Rony Sfeir
- Reference Center for Chronic Esophageal Anomalies, Reference Center for Rare Esophageal Diseases, INFINITE Lille
| | | | | | | | - Madeleine Aumar
- Reference Center for Chronic Esophageal Anomalies, Reference Center for Rare Esophageal Diseases, INFINITE Lille
| | | | | | - Sabine Irtan
- University Hospital Armand Trousseau, Paris-Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, Centre de Recherche St Antoine Inserm UMRS.938, Paris, France
| | | | | | | | | | | | | | | | | | | | - Hossein Allal
- University Hospital of Montpellier, Montpellier, France
| | | | | | | | | | | | | | | | | | | | | | | | - Corinne Borderon
- University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | | | - Cécilia Tolg
- University Hospital of Fort de France, Martinique, France
| | - Yann Chaussy
- University Hospital of Besançon, Besançon, France
| | | | | | - Elodie Drumez
- METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales.,Department of Biostatistics, Centre Hospitalier Universitaire de Lille, University Lille, Lille, France
| | - Sawsan El Mourad
- Reference Center for Chronic Esophageal Anomalies, Reference Center for Rare Esophageal Diseases, INFINITE Lille.,General Hospital of Arras, Arras, France
| | - Caroline Thumerelle
- Reference Center for Chronic Esophageal Anomalies, Reference Center for Rare Esophageal Diseases, INFINITE Lille
| | - Frédéric Gottrand
- Reference Center for Chronic Esophageal Anomalies, Reference Center for Rare Esophageal Diseases, INFINITE Lille
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6
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Mégier C, Fouquet V, Senat MV, Letourneau A, Bouchghoul H. [Antenatal ultrasound prediction of esophageal atresia type]. ACTA ACUST UNITED AC 2020; 48:806-813. [PMID: 32522613 DOI: 10.1016/j.gofs.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Esophageal atresia (EA) is a rare congenital malformation of the upper aerodigestive tract, which can be diagnosed antenatally in 50-65% of cases. Postnatal management differs according to the type of EA. No studies have evaluated the correlation of antenatal ultrasound findings with the type of EA. OBJECTIVE The main objective is to study the association between antenatal ultrasound signs and the type of EA. The secondary objective is to study the association between postnatal morbidity and the type of EA. METHOD We conducted a single-center retrospective study between May 2010 and August 2019. Fetuses with suspected prenatal EA and postnatal diagnosis confirmation were included. Postnatal confirmation of EA was performed during surgery for live births and by fetopathological examination for termination of pregnancy. Prenatal signs and postnatal morbidity were compared according to the type of EA. RESULTS We included 15 cases of postnatally confirmed EA, including 9 type 1EA, 5 type 3EA and 1 type 4EA (11 live births and 4 terminations of pregnancy). The gestational age at diagnosis was earlier in type 1EA: 22+0 [6-21,21-24] versus 30+0 [28+0-32+0] (P=0.03). Compared to type 3EA, type 1EA had a higher incidence of non-visible stomach bubble (89% versus 40%, P=0.09) and upper esophageal cul-de-sac dilatation (56% versus 0%, P=0.09). Neonatal morbidity in type 1EA was more severe with a longer hospital stay in neonatal intensive care. CONCLUSION The antenatal ultrasound signs seem to be more pronounced in case of type 1EA. Type 1EA is associated with severe morbidity compared to Type 3EA. Improving prenatal diagnosis of EA and its type allows a more accurate prognostic evaluation.
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Affiliation(s)
- C Mégier
- Service de gynécologie obstétrique, hôpital Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France
| | - V Fouquet
- Service de chirurgie pédiatrique, hôpital Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France
| | - M V Senat
- Service de gynécologie obstétrique, hôpital Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France
| | - A Letourneau
- Service de gynécologie obstétrique, hôpital Antoine-Béclère, AP-HP, Clamart, France
| | - H Bouchghoul
- Service de gynécologie obstétrique, hôpital Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France.
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7
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van Lennep M, Singendonk MMJ, Dall'Oglio L, Gottrand F, Krishnan U, Terheggen-Lagro SWJ, Omari TI, Benninga MA, van Wijk MP. Oesophageal atresia. Nat Rev Dis Primers 2019; 5:26. [PMID: 31000707 DOI: 10.1038/s41572-019-0077-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Oesophageal atresia (EA) is a congenital abnormality of the oesophagus that is caused by incomplete embryonic compartmentalization of the foregut. EA commonly occurs with a tracheo-oesophageal fistula (TEF). Associated birth defects or anomalies, such as VACTERL association, trisomy 18 or 21 and CHARGE syndrome, occur in the majority of patients born with EA. Although several studies have revealed signalling pathways and genes potentially involved in the development of EA, our understanding of the pathophysiology of EA lags behind the improvements in surgical and clinical care of patients born with this anomaly. EA is treated surgically to restore the oesophageal interruption and, if present, ligate and divide the TEF. Survival is now ~90% in those born with EA with severe associated anomalies and even higher in those born with EA alone. Despite these achievements, long-term gastrointestinal and respiratory complications and comorbidities in patients born with EA are common and lead to decreased quality of life. Oesophageal motility disorders are probably ubiquitous in patients after undergoing EA repair and often underlie these complications and comorbidities. The implementation of several new diagnostic and screening tools in clinical care, including high-resolution impedance manometry, pH-multichannel intraluminal impedance testing and disease-specific quality of life questionnaires now provide better insight into these problems and may contribute to better long-term outcomes in the future.
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Affiliation(s)
- Marinde van Lennep
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology and Nutrition, Amsterdam, The Netherlands
| | - Maartje M J Singendonk
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology and Nutrition, Amsterdam, The Netherlands
| | - Luigi Dall'Oglio
- Digestive Endoscopy and Surgery Unit, Bambino Gesu Children's Hospital-IRCCS, Rome, Italy
| | - Fréderic Gottrand
- CHU Lille, University Lille, National Reference Center for Congenital Malformation of the Esophagus, Department of Pediatric Gastroenterology Hepatology and Nutrition, Lille, France
| | - Usha Krishnan
- Department of Paediatric Gastroenterology, Sydney Children's Hospital, Sydney, New South Wales, Australia
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Suzanne W J Terheggen-Lagro
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric Pulmonology, Amsterdam, The Netherlands
| | - Taher I Omari
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Center for Neuroscience, Flinders University, Adelaide, South Australia, Australia
| | - Marc A Benninga
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology and Nutrition, Amsterdam, The Netherlands.
| | - Michiel P van Wijk
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology and Nutrition, Amsterdam, The Netherlands
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit, Pediatric Gastroenterology, Amsterdam, The Netherlands
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8
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Khanna K, Dhua AK, Bhatnagar V. Antenatally Diagnosed Surgical Conditions: Fetus As Our Patient. Indian J Pediatr 2018; 85:1101-1109. [PMID: 29968133 DOI: 10.1007/s12098-018-2732-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/30/2018] [Indexed: 12/30/2022]
Abstract
In today's era of improved antenatal care and screening modalities (3D high-resolution fetal ultrasound, fetal magnetic resonance imaging, fetal echocardiography, maternal serum markers and fetal blood sampling), an early diagnosis of surgical fetal abnormalities is routinely possible. A thorough knowledge about the incidence of such defects, the means of detection and evaluation, the scope of fetal intervention, postnatal management and long-term outcomes of common surgical conditions diagnosed antenatally is essential. This knowledge would not only help in proper patient care and management but also to ensure appropriate counselling of the expectant parents. This article highlights the fetal anomalies which are amenable to some form of fetal intervention from a pediatric surgical perspective as also those which can be treated after birth.
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Affiliation(s)
- Kashish Khanna
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Anjan Kumar Dhua
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Veereshwar Bhatnagar
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India.
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9
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Garabedian C, Vaast P, Verpillat P, Sfeir R, Coulon C, Houfflin-Debarge V. Prenatal diagnosis of esophageal atresia: A case of triple negative screening. J Gynecol Obstet Hum Reprod 2018; 48:69-70. [PMID: 30347256 DOI: 10.1016/j.jogoh.2018.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/12/2018] [Accepted: 10/17/2018] [Indexed: 11/27/2022]
Abstract
Esophageal atresia (EA) is prenatally diagnosed in less than one third of the cases and is usually only suspected. Recently, magnetic resonance imaging (MRI) with dynamic sequence and biochemistry of the amniotic fluid have been proposed to enhance prenatal diagnosis of EA. We report the case of a triple negative screening (ultrasound, MRI with dynamic sequence and biochemistry of the amniotic fluid) with a postnatal diagnosis of EA type III with a small defect. Even using second line tests, prenatal diagnosis of EA remains a challenge.
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Affiliation(s)
- C Garabedian
- CHU Lille, Department of Obstetrics, F-59000 Lille, France; University of Lille, EA 4489 - Perinatal Environment and Health, F-59000 Lille, France.
| | - P Vaast
- CHU Lille, Department of Obstetrics, F-59000 Lille, France
| | - P Verpillat
- CHU Lille, Department of Radiology, F-59000 Lille, France
| | - R Sfeir
- CHU Lille, Department of Paediatric Surgery, F-59000 Lille, France; CHU Lille, CRACMO Reference Center for Rare Esophageal Diseases, University Lille, LIRIC UMR 995, F-59000 Lille, France
| | - C Coulon
- CHU Lille, Department of Obstetrics, F-59000 Lille, France
| | - V Houfflin-Debarge
- CHU Lille, Department of Obstetrics, F-59000 Lille, France; University of Lille, EA 4489 - Perinatal Environment and Health, F-59000 Lille, France
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