BARIUM SWALLOW INTRODUCTION Barium swallow is a dedicated

BARIUM SWALLOW

INTRODUCTION Ø Barium swallow is a dedicated test of the pharynx, esophagus, and proximal stomach, and may be performed as a single or double contrast study. Ø To evaluate the entire pathway from the lips to the gastric fundus.

INDICATIONS ØDysphagia and obstruction. ØPain during swallowing. ØAssessment of mediastinal masses. ØAssessment of left atrial enlargement. ØPre-op assessment of carcinoma bronchus and oesophagus. ØMotility disorders of oesophagus, E. g. : Achalasia(damage to nerves) and diffuse oesophageal spasm, scleroderma. ØAssessment of site of perforation.

CONTRAINDICATIONS ØTracheo oesophageal fistula. ØPerforation. NOTE : Water-soluble contrast agents should be used instead of barium in this conditions ØPregnancy

PREPARATION ØOver night fasting or atleast 4 hours fasting ØDo not dehydrate the patient ØLow residue diet. ØAvoiding smoking and chewing gum

CONTRAST Ø 100% Barium sulphate paste. Ø 80% Barium sulphate suspension. Ø 30% Barium sulphate suspension for high k. V technique. Ø 200 -250% high density, low viscosity for double contrast study.

EVALUATION OF PHARYNX ØScout films are obtained to rule out any foreign body, abscess or fistula ØOne mouthful (about 10 -15 ml) of contrast media (Barium sulphate paste) is given and fluoroscopic observation of the act of deglutition is observed in frontal and lateral view with the patient erect. ØRight lateral views should be obtained initially to rule out aspiration or penetration, then frontal views are obtained. ØLateral film is taken in erect and frontal film in supine position.

EVALUATION OF OESOPHAGUS Single Contrast ØMultiple mouthfuls of 80% w /v Barium suspension are given. Follow the barium bolus down the oesophagus and observe the peristalsis always in supine position. ØFilms are exposed in erect position RAO, LAO, frontal and lateral views when the oesophagus is well distended. ØIn RAO position esophagus is projected clear of the spine. ØMucosal film is taken in RAO after the oesophagus is empty. Then the fundus of the stomach & gastro oesophageal junction are assessed with spot films in different obliquities in erect and recumbent positions.

DOUBLE CONTRAST ØBarium contrast should be high density, low viscosity (200 to 250%). Ø 15 -20 ml Barium is given in the mouth and the patient is asked to swallow. Then effervescent powder is given with another mouthful of barium. ØIn erect position, gas tends to stay up, resulting in adequate distension which stays for longer time as compared to supine position. ØProne position also retains more gas within the oesophagus and gives adequate distension. ØFilming is done in frontal, lateral, RAO and LAO.