OC14.06: Dynamic esophageal patency assessment: a novel method to improve prenatal exclusion of esophageal atresia

Esophageal atresia (EA) is an underdiagnosed major anomaly, with a prenatal detection rate of about 30%. Currently, there is no validated prenatal method of confirming an intact esophagus. We propose a novel dynamic esophageal patency assessment (DEPA) based on the demonstration of continuous uninterrupted fluid propagating through the fetal esophagus during swallowing. The aim of the study was to assess the performance indices and feasibility of DEPA. A comprehensive anomaly scan was carried out with the investigational DEPA supplement. The fetal esophagus was observed during swallowing and patency was confirmed when a continuous fluid wave propagated through the esophagus. Cases that demonstrated fluid propagation were classified DEPA-negative. Cases that demonstrated an esophageal pouch, were classified DEPA-positive. Cases that failed to demonstrate fluid propagation or a pouch were classified as DEPA-undetermined. Test performance indices were calculated. Over a period of six months, 88 patients were enrolled. The median (IQR) gestational age at time of scan was 31.4 (27.4–35.3) weeks. Of 88 fetuses enrolled, 84 (95.5%) were DEPA negative, 3 (3.4%) were DEPA positive and 1 (1.1%) was DEPA undetermined. In 2 of 3 DEPA positive cases EA was confirmed, in the remaining case the couple declined postmortem examination. The sensitivity, specificity, positive and negative predictive values of DEPA were 100%. The median (IQR) time required to complete DEPA was 5 (range 3–13) minutes. DEPA is a feasible and highly effective method with acceptable time frame for ascertaining an intact esophagus in suspected cases, thereby, enabling the exclusion of esophageal atresia.