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Outcome of fetal gastro-intestinal cysts: a systematic review and meta-analysis
Luisa Marrone1, Marco Liberati1, Asma Khalil2
1Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti-Pescara, Italy.
Insights
Fetal gastrointestinal (GI) cysts are typically benign, with about a third resolving spontaneously. Prenatal ultrasound demonstrates good accuracy in detecting these anomalies, and surgical complication rates are low.
Area of Science:
- Perinatal Medicine
- Pediatric Surgery
- Medical Imaging
Background:
- Fetal gastrointestinal (GI) cysts represent a spectrum of congenital anomalies with varying clinical significance.
- Accurate prenatal diagnosis and understanding of outcomes are crucial for appropriate management.
Purpose of the Study:
- To evaluate the natural history and outcomes of fetal GI cysts.
- To determine the diagnostic accuracy of prenatal ultrasound in identifying these anomalies.
Main Methods:
- A systematic review and meta-analysis of studies reporting on fetal GI cysts.
- Data synthesis using meta-analyses of proportions and a hierarchical summary receiver operating characteristic (HSROC) model.
Main Results:
- Ten studies were included, with 27% of cysts resolving pre- or postnatally.
- Clinical symptoms occurred in 31.1% of cases, and 50.6% required surgery with low post-surgical complication rates (6.1%).
- Prenatal ultrasound exhibited high sensitivity (94.5%) and specificity (97.7%) for detecting GI cysts.
Conclusions:
- Fetal GI cysts are generally benign, with a significant proportion resolving spontaneously.
- Prenatal ultrasound is a reliable tool for diagnosing fetal GI cysts, aiding in early management decisions.
- While some infants develop symptoms or require surgery, the overall prognosis is favorable.
Objectives:
To explore the outcome of fetal gastrointestinal (GI) cysts and to ascertain the detection rate of prenatal ultrasound in identifying these anomalies.
Methods:
Medline and Embase databases were searched. The outcomes explored were: resolution of the cyst, additional GI anomalies detected only at birth, clinical symptoms, need for surgery, post-surgical complications and diagnostic accuracy. Meta-analyses of proportions and hierarchical summary receiver operating characteristics (HSROC) model were used to analyse the data.
Results:
Ten studies were included; 27.0% (95% CI 2.6-64.4) of the cysts resolved either pre or post-natally. Additional GI anomalies were detected in 6.0% (95% CI 1.1-14.7). Clinical symptoms occurred in 31.1% (95% CI 14.9-50.2), while 50.6% (95% CI 10.0-90.8) had surgery. Post-surgical complications occurred in 6.1% (95% CI 0.2-19.6). Overall detection rate of prenatal ultrasound in correctly identifying GI cysts was good (sensitivity: 94.5%, 95% CI: 39.1-99.8; specificity: 97.7%, 95% CI 89.9-99.5).
Conclusion:
GI cysts are usually benign. Clinical symptoms occur in approximately one third of children. About one third of the cysts resolves, while the rate of complications after surgery is low. Prenatal ultrasound has an overall good diagnostic accuracy in identifying these anomalies. © 2016 John Wiley & Sons, Ltd.
