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CME Credit Offered
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Poster Session 4

(1212) Determining time course of complex gastroschisis development in fetal lambs with standardized abdominal wall defect

Friday, January 31, 2025
4:00 PM – 6:00 PM  

    Submitting Author(s)

  • Tomohiro Arai, MD

    My FetUZ Fetal Research Center, Universitary Hospital Leuven
    Leuven, Vlaams-Brabant, Belgium

    • Coauthor(s)

  • Jan A. Deprest, FRCOG, MD, PhD

    Professor Obstetrics Gynaecology
    My FetUZ Fetal Research Center, Universitary Hospital Leuven
    Leuven, Vlaams-Brabant, Belgium

  • MS

    Marianna Scuglia, MD

    My FetUZ Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences
    My FetUZ Fetal Research Center, Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
    Leuven, Vlaams-Brabant, Belgium

  • DB

    David Basurto, MD

    Academic Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences
    My FetUZ Fetal Research Center, Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
    Leuven, Vlaams-Brabant, Belgium

  • WT

    Wasinee Tianthong, MD

    My FetUZ Fetal Research Center, Universitary Hospital Leuven
    Leuven, Vlaams-Brabant, Belgium

  • WK

    Watananirum Kanokwaroon, MD

    My FetUZ Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences
    My FetUZ Fetal Research Center, Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
    Leuven, Vlaams-Brabant, Belgium

  • EV

    Emma Van Den Eede

    My FetUZ Fetal Research Center, Universitary Hospital Leuven
    Leuven, Vlaams-Brabant, Belgium

  • SV

    Simen Vergote, MD

    My FetUZ Fetal Research Center, Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
    Leuven, Vlaams-Brabant, Belgium

  • TB

    Tom Bleeser, MD, PhD

    My FetUZ Fetal Research Center, Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
    Leuven, Vlaams-Brabant, Belgium

  • FR

    Francesca M. Russo, MD, PhD

    My FetUZ Fetal Research Center, Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
    Leuven, Vlaams-Brabant, Belgium

  • KS

    Keswani Sundeep, MD

    Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine and Texas Children's Hospital
    Houston, Texas, United States

    • Presenting Author(s)

  • Michael A. Belfort, MD, PhD (he/him/his)

    Professor, Chairman
    Texas Children’s Hospital and Baylor College of Medicine
    Houston, TX, United States

    • Coauthor(s)

  • Luc Joyeux, MD, PhD

    Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine and Texas Children's Hospital
    Houston, Texas, United States

Objective: Complex gastroschisis is the severe type of gastroschisis, characterized by intestinal atresia, stenosis, volvulus, perforation, or necrosis. A systematic review (Arai, Prenatal Diagnosis 2024) demonstrated complex gastroschisis can be reliably surgically induced in fetal lambs using a 1.5 cm left lateral abdominal wall defect stabilized by a 1.5 cm silicone ring. It results in a 60% complex gastroschisis and a 40% fetal death rate by term. We aimed to identify from what time point after induction gastroschisis becomes complex.

Study Design: Gastroschisis was induced in 75-day (term=145d) fetal lambs, which were harvested between 13 and 21d post-induction. Primary outcome was the occurrence of complex gastroschisis; secondary outcomes included in-vivo ultrasound characteristics of the bowel, ex-vivo bowel contractility, and histology (Fig. 1). We first assessed 6 animals at 13-16d and 6 at 17-21d post-induction to sufficiently power the study.

Results: In the first 12 lambs, 0/6 developed complex gastroschisis at 13-16d, whereas this was present in 4/6 at 17-21d. Hypothesizing a complex gastroschisis rate of 10% at 13-16d and 65% at 17-21d, we added 6 lambs (total:18). Finally, 17-21d post-induction, complex gastroschisis was present in the vast (5/8=63%) majority, whereas it was simple at 13-16d (9/10=90%, p=0.0265, 2-sided Fisher exact). Bowels from lambs with complex gastroschisis display inappropriate bowel relaxation on contractility testing and a thicker muscular layer on histology. Remarkably, lambs with complex gastroschisis presented with intra-abdominal bowel dilation on prenatal ultrasound at obduction; a 2.58mm cut-off could identify complex with 100% sensitivity and 60% specificity.

Conclusion: Gastroschisis can be reliably induced in fetal lambs. This leads to simple gastroschisis early on (13-16d), whereafter (17-21d) complex gastroschisis becomes very common. Complex gastroschisis coincided with intra-abdominal bowel dilation on ultrasound, which may be used as a non-invasive biomarker. This defines a time window of opportunity and signs to guide experiments for prenatal intervention.