Prenatal diagnosis of esophageal atresia with the pouch sign

Abstract

A 19-year-old

Management and outcome of neonates with a prenatal diagnosis of esophageal atresia type A: A population‐based study

“…However, the positive predictive value of these 2 signs is low (between 40% and 56%), and the prenatal sonographic diagnosis can be improved by direct visualization of the fluid-filled, blind-ending esophagus during fetal swallowing or upper neck "pouch sign." 8,10,21,22 This sign was described in 46% of our prenatal group, a rate similar to that reported by Brantberg et al (ie, visible esophageal pouch in 43% of 21 cases of prenatally diagnosed EA) and higher than in our first study, which included all EA types. 7,16 Furthermore, in France, a sonographic evaluation is systematically recommended during the third trimester (at about 32 weeks gestation).…”

“…6 Prenatal sonographic suspicion of EA relies on indirect signs (ie, presence of a small or nonvisible fetal stomach bubble associated with polyhydramnios) and direct signs (ie, blind-ending esophagus during fetal swallowing or "pouch sign"). [7][8][9][10] Using dynamic sequences, MRI improves prenatal diagnosis. 11,12 Amniotic fluid allows the dosage of α-fetoprotein and digestive enzyme gamma-glutamyl transpeptidase.…”

Contemporary management and outcomes for infants born with oesophageal atresia

“…However, this varied with the type of OA: only 14·3 per cent of type C cases were detected antenatally, compared with two-thirds (14 of 21) of cases with atresia without lower pouch fistula (types A and B). Dilatation of the upper oesophagus on prenatal scan has been reported as a feature associated with OA diagnosed antenatally 17 , although a recent paper has cast doubt on the significance of this sign 18 , which was found in only two of the present infants. The presence of associated anomalies in more than half of the infants, and their distribution, is consistent with previous studies 2,14 .…”

Esophageal obstruction—prenatal detection rate and outcome

“…Methods for postnatal visualization of the distal pouch in cases with esophageal atresia without fistula are well established13, 15–17. In recent decades, prenatal visualization of the proximal esophageal pouch has received increasing interest18–22 because of its high specificity in the diagnosis of esophageal atresia19, 20. It has also been suggested that the level of the pouch may be of prognostic value23, 24.…”