The value of preoperative CT scan in newborns with type C esophageal atresia

Su, Peng; Huang, Ying; Wang, Weilin; Zhang, Zhibo

doi:10.1007/s00383-012-3082-x

Cited by 9 publications

(4 citation statements)

References 10 publications

(11 reference statements)

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“…This finding obviates the need for a preoperative CT scan and prevents unnecessary radiation exposure in a neonate as advised by some authors. [6789]…”

Section: Discussionmentioning

confidence: 99%

“…For the purpose of the assessment of this gap length, various investigations including computed tomography (CT) scan have been advised by many authors and performed at many centers worldwide. [6789] A diagnostic plain radiograph with a nasogastric tube in situ might provide reliable information regarding the gap length if interpreted carefully without involving additional risk and cost.…”

Section: Introductionmentioning

confidence: 99%

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Prediction of gap length by plain radiograph of chest with nasogastric tube in the upper esophagus in patients with esophageal atresia and distal tracheoesophageal fistula

Rassiwala

Yadav

Choudhury

et al. 2019

J Indian Assoc Pediatr Surg

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Aim:This study was aimed at prediction of the gap length between the two esophageal ends in cases of esophageal atresia and distal tracheoesophageal fistula (EA-TEF) by preoperative radiography with a nasogastric tube in the upper esophagus and its correlation with intraoperatively measured gap length.Materials and Methods:All consecutive cases of EA-TEF were prospectively included in this study. Plain radiographs were taken with an 8 Fr nasogastric tube inserted in the upper esophageal pouch till its arrest. The patients were grouped into T1-T2; T2-T3; T3-T4; and T4 groups depending on the thoracic vertebral level of arrest of the NG tube on the radiograph. Intraoperative gap between the two esophageal ends was measured with Vernier caliper, and the patients were grouped into A, B, and C groups based on gap length (gap length >2.1 cm; >1–≤2 cm; and ≤1 cm). The operative gap groups were compared with the radiography groups.Results:A total number of 118 cases were included over a period of 3 years. The arrest of nasogastric tube at T1-T2 and T2-T3 vertebral level corresponded to gap length Group A in 39/41 (95.12%) * patients. In gap length Group B, the arrest of tube at T2-T3 and T3-T4 vertebral level was seen in 44/44 (100%)* patients, in gap length Group C, the arrest of tube was noted at T3-T4 and T4 vertebral level in 31/33 (93.93%)* patients (*P < 0.001).Conclusion:Prediction of gap length by vertebral level of arrest of the nasogastric tube in the upper pouch in a preoperative chest X-ray correlated well with intra operatively measured gap length in cases of EA-TEF.

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“…This finding obviates the need for a preoperative CT scan and prevents unnecessary radiation exposure in a neonate as advised by some authors. [6789]…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prediction of gap length by plain radiograph of chest with nasogastric tube in the upper esophagus in patients with esophageal atresia and distal tracheoesophageal fistula

Rassiwala

Yadav

Choudhury

et al. 2019

J Indian Assoc Pediatr Surg

View full text Add to dashboard Cite

show abstract

“…This finding obviates the need for a preoperative computed tomography scan to determine the gap length and prevents unnecessary radiation exposure in a neonate as advised by some authors. [ 15 16 17 ]…”

Section: Discussionmentioning

confidence: 99%

Determinants of gap length in esophageal atresia with tracheoesophageal fistula and the impact of gap length on outcome

Rassiwala

Choudhury

Yadav

et al. 2016

J Indian Assoc Pediatr Surg

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Aim:This study was aimed at identifying factors which may affect the gap length in cases of esophageal atresia with tracheoesophageal fistula (EA-TEF) and whether gap length plays any role in determining the outcome.Materials and Methods:All consecutive cases of EA-TEF were included and different patient parameters were recorded. Plain radiographs with a nasogastric tube in the upper esophagus were taken. Patients were grouped into T1-T2; T2-T3; T3-T4; and T4 depending on the thoracic vertebral level of the arrest of the tube. During surgery, the gap length between the pouches was measured using a Vernier caliper and the patients were grouped into A, B, and C (gap length >2.1 cm; >1-≤2 cm and ≤1 cm). The operative gap groups were compared with the radiography groups and the other recorded parameters.Results:Total numbers of cases were 69. Birth weight was found to be significantly lower in Group A (mean = 2.14 kg) as compared to Group B (mean = 2.38 kg) and Group C patients (mean = 2.49 kg) (P = 0.016). The radiographic groups compared favorably with the intraoperative gap length groups (P < 0.001). The need for postoperative ventilation (70.83% in Group A vs. 36.84% in Group C, P = 0.032) and mortality (62.5%, 26.9% and 15.8% in Group A, B, and C, respectively, P = 0.003) co-related significantly with the gap length.Conclusion:Birth weight had a direct reciprocal relationship with the gap length. Radiographic assessment correlated with intraoperative gap length. Higher gap length was associated with increased need for postoperative ventilation and poor outcome.

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“…A few studies have evaluated the use of pre-operative computerized tomography scanning in cases of suspected EA/TEFs. While these studies have demonstrated success in identifying the anatomy of the TED and defining the esophageal gap length, they have also shown that computerized tomography scans expose infants to a significant amount of ionizing radiation indicating that the risks may outweigh the benefits [12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Magnetic Resonance Imaging-Based Evaluation of Anatomy and Outcome Prediction in Infants with Esophageal Atresia

Marks

Higano²,

Kotagal³

et al. 2023

Neonatology

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Introduction: There is currently no validated diagnostic modality to characterize the anatomy and predict outcomes of tracheal esophageal defects, such as esophageal atresia (EA) and tracheal esophageal fistulas (TEFs). We hypothesized that ultra-short echo-time MRI would provide enhanced anatomic information allowing for evaluation of specific EA/TEF anatomy and identification of risk factors that predict outcome in infants with EA/TEF. Methods: In this observational study, 11 infants had pre-repair ultra-short echo-time MRI of the chest completed. Esophageal size was measured at the widest point distal to the epiglottis and proximal to the carina. Angle of tracheal deviation was measured by identifying the initial point of deviation and the farthest lateral point proximal to the carina. Results: Infants without a proximal TEF had a larger proximal esophageal diameter (13.5 ± 5.1 mm vs. 6.8 ± 2.1 mm, p = 0.07) when compared to infants with a proximal TEF. The angle of tracheal deviation in infants without a proximal TEF was larger than infants with a proximal TEF (16.1 ± 6.1° vs. 8.2 ± 5.4°, p = 0.09) and controls (16.1 ± 6.1° vs. 8.0 ± 3.1°, p = 0.005). An increase in the angle of tracheal deviation was positively correlated with duration of post-operative mechanical ventilation (Pearson r = 0.83, p < 0.002) and total duration of post-operative respiratory support (Pearson r = 0.80, p = 0.004). Discussion: These results demonstrate that infants without a proximal TEF have a larger proximal esophagus and a greater angle of tracheal deviation which is directly correlated with the need for longer post-operative respiratory support. Additionally, these results demonstrate that MRI is a useful tool to assess the anatomy of EA/TEF.

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The value of preoperative CT scan in newborns with type C esophageal atresia

Abstract: Preoperative CT scan could provide more accurate information about the origin of the fistula and the interpouch distance in type C EA and played a crucial role in planning the surgical strategy.

Cited by 9 publications

References 10 publications

Prediction of gap length by plain radiograph of chest with nasogastric tube in the upper esophagus in patients with esophageal atresia and distal tracheoesophageal fistula

Prediction of gap length by plain radiograph of chest with nasogastric tube in the upper esophagus in patients with esophageal atresia and distal tracheoesophageal fistula

Determinants of gap length in esophageal atresia with tracheoesophageal fistula and the impact of gap length on outcome

Magnetic Resonance Imaging-Based Evaluation of Anatomy and Outcome Prediction in Infants with Esophageal Atresia

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