VP04.04: Examining the feasibility of systematic imaging the esophagus at the first trimester anomaly scan

To evaluate the feasibility of imaging the entire esophageal length during the early anomaly scan and present a case with disrupted esophageal continuity that later (at the 2nd trimester) proved to have esophageal atresia (EA). This was a prospective observational study of 125 patients. Patients carrying a singleton pregnancy were recruited during the routine early anomaly scan at 13-16 weeks of gestation. The entire length of the esophagus was captured in a single sonographic frame at the mid sagittal plane. The esophagus was imaged as a bundle of numerous echogenic lines running posterior to the trachea and right main bronchus (in the neck and upper thorax) and running posterior and adjacent to the heart (at the lower thorax). Medical records of the antenatal follow-up were reviewed. Complete visualisation of the esophagus (neck to diaphragm) was possible in 124 patients, using a one-shot technique. Passage of fluid through the thoracic esophagus was identified in 23 cases. The mean time required for detection of the esophagus was on average 12.95 +/-7 (SD) sec. In one case, the cervical segment of the esophagus was demonstrated clearly while the lower thoracic segment was not demonstrated despite robust efforts. At the mid trimester anomaly scan the stomach could not be visualised and EA was evident by repeated demonstration of a cervical esophageal pouch. The couple opted for pregnancy termination. It is feasible to demonstrate esophageal continuity during the early stages of pregnancy. The early scan is a window of opportunity for clear and undisturbed visualisation of the entire esophagus. This may serve as a new efficient tool to screen for EA in early pregnancy.