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Imaging Tips for Performing a Perfect Barium Swallow

2019; Radiological Society of North America; Volume: 39; Issue: 5 Linguagem: Inglês

10.1148/rg.2019190055

1527-1323

David J. DiSantis, Jacob I. Lewis, Christine O. Menias, Dennis M. Balfe, Desiree E. Morgan, Joseph G. Cernigliaro,

Tracheal and airway disorders

HomeRadioGraphicsVol. 39, No. 5 PreviousNext Gastrointestinal ImagingFree AccessRadioGraphics Fundamentals | Online PresentationImaging Tips for Performing a Perfect Barium SwallowDavid J. DiSantis , Jacob I. Lewis, Christine O. Menias, Dennis M. Balfe, Desiree E. Morgan, Joseph G. CernigliaroDavid J. DiSantis , Jacob I. Lewis, Christine O. Menias, Dennis M. Balfe, Desiree E. Morgan, Joseph G. CernigliaroAuthor AffiliationsFrom the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (D.J.D., J.I.L., J.G.C.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (D.M.B.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (D.E.M.).Address correspondence to D.J.D. (e-mail: [email protected]).David J. DiSantis Jacob I. LewisChristine O. MeniasDennis M. BalfeDesiree E. MorganJoseph G. CernigliaroPublished Online:Sep 9 2019https://doi.org/10.1148/rg.2019190055MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractThe full digital presentation is available online.Along with all gastrointestinal (GI) fluoroscopic studies, the number of esophagrams being performed has fallen in recent decades. This trend stems from a concatenation of circumstances and perceptions that include (a) a growing shortage of teachers experienced in performing GI fluoroscopy; (b) relatively low reimbursement for fluoroscopic procedures; (c) the common view of barium radiology as labor intensive, time consuming, and technically demanding; and (d) an endoscopy-first mentality among nonradiologist physicians that undervalues the usefulness of obtaining barium swallow studies. Yet, fluoroscopic studies of the esophagus are not disappearing. Medicare data provided by the American College of Radiology Harvey L. Neiman Health Policy Institute indicate that in 2017, more than 679 000 esophagrams were performed in the United States alone, along with 1.3 million barium swallow studies.In trained hands, barium esophagography offers an excellent tool for assessing swallowing, evaluating esophageal morphology and motility, and demonstrating postoperative complications. As a single test of both structure and function, its role is unique. Compared with esophageal endoscopy, manometry, and pH monitoring, barium esophagography is quick, noninvasive, less expensive to perform, and does not require sedation. Because fluoroscopic studies are less costly and widely available, they offer a particularly practical option in less sophisticated and less affluent health care settings.Consequently, both single- and dual-phase esophagrams remain valuable tools in the contemporary radiology armamentarium, and practitioners should be facile with both. While single-phase esophagrams are particularly appropriate for postoperative evaluation, imaging a patient who is debilitated or immobile, assessing esophageal motility, and depicting rings and strictures, dual-phase esophagrams provide greater sensitivity for detecting mucosal pathologic conditions such as infectious, inflammatory, and reflux esophagitides. Fastidious technique is essential to prevent false-negative and false-positive results. For example, excess barium can hide a mucosal pathologic finding, while undissolved effervescent crystals can mimic pathologic conditions.Because proper technique is fundamental for obtaining quality barium esophagrams, the central aim of our online presentation is to offer step-by-step guidance on how to perform the procedure. Written directions describe the sequence of steps, the use of contrast material, and appropriate patient positioning for obtaining optimal images. This online presentation is supplemented with a 6-minute instructional video that simultaneously displays what is happening in the fluoroscopy suite and the imaging results on the fluoroscopy screen. In addition, we have provided a short how-to guide or "recipe card," which is a suitable size for mounting on a fluoroscope tower for quick reference during procedures. Finally, we include examples of the wide array of pathologic conditions detectable with these newly honed esophagographic skills and provide advice regarding the best techniques to use for detecting them (Figs 1, 2).Figure 1. Lateral posterior oblique double-contrast esophagram shows a stacked-rings contour of the lumen, a finding indicative of eosinophilic esophagitis.Figure 1.Download as PowerPointOpen in Image Viewer Figure 2. Left posterior oblique single-contrast esophagram shows cervical esophageal strictures (arrows) in a patient with lichen planus.Figure 2.Download as PowerPointOpen in Image Viewer Because of its versatility, barium esophagography is one GI fluoroscopic study that continues to be performed in nearly all radiology practices every day. Since, for the foreseeable future, we radiologists will continue to be performing these studies, our patients deserve that we learn to perform them well.Disclosures of Conflicts of Interest.—D.J.D.Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: honorarium and travel expenses for four lectures from the University of California at San Francisco. Other activities: disclosed no relevant relationships.AcknowledgmentsThe authors wish to acknowledge Lauren Bacon, BAS, RT, and James Barlow for their invaluable help.D.E.M. supported by a GE Healthcare grant.Recipient of a Certificate of Merit award for an education exhibit at the 2018 RSNA Annual Meeting.The author D.J.D. has provided disclosures; all other authors have disclosed no relevant relationships.Suggested ReadingsKoehler RE, Weyman PJ, Oakley HF. Single- and double-contrast techniques in esophagitis. AJR Am J Roentgenol 1980;135(1):15–19. Crossref, Medline, Google ScholarLevine MS, Carucci LR, DiSantis DJ, et al. Consensus Statement of Society of Abdominal Radiology Disease-Focused Panel on Barium Esophagography in Gastroesophageal Reflux Disease. AJR Am J Roentgenol 2016;207(5):1009–1015. Crossref, Medline, Google ScholarLevine MS, Rubesin SE. Diseases of the esophagus: a pattern approach. Abdom Radiol 2017;42(9):2199–2218. Crossref, Google ScholarRubesin SE, Jessurun J, Robertson D, Jones B, Bosma JF, Donner MW. Lines of the pharynx. RadioGraphics 1987;7(2):217–237. Link, Google ScholarTao TY, Menias CO, Herman TE, McAlister WH, Balfe DM. Easier to swallow: pictorial review of structural findings of the pharynx at barium pharyngography. RadioGraphics 2013;33(7):e189–e208. Link, Google ScholarArticle HistoryReceived: Mar 10 2019Revision requested: May 1 2019Revision received: May 30 2019Accepted: June 7 2019Published online: Sept 09 2019Published in print: Sept 2019 FiguresReferencesRelatedDetailsCited ByImaging Review of Gastrointestinal Motility DisordersAvinash K. Nehra, Shannon P. Sheedy, C. Daniel Johnson, Kristina T. Flicek, Sudhakar K. Venkatesh, Jay P. Heiken, Michael L. Wells, Eric C. Ehman, John M. Barlow, Joel G. Fletcher, Michael C. Olson, Adil E. Bharucha, David A. Katzka, Jeff L. 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