Utilization of the emergent barium swallow

Abstract

The purpose of this study was to evaluate use of the emergent barium swallow. One hundred thirty-four patients were referred for contrast esophagraphy directly from the emergency department of our hospital and were reviewed retrospectively. Clinical review at the time of the contrast examination revealed that 28 patients actually had features for which gastroduodenal or small bowel pathology was suspected. This left 106 patients with true esophageal studies. Fifty-six patients were suspected of having perforation. Contrast esophagram revealed esophageal disruption in six cases (11%). There were no false-negatives as determined by clinical follow-up. These six patients also had abnormal preliminary chest radiographs.

Fifty patients had swallowing difficulties. Of these, 19 were suspected of having an impacted foreign body. A foreign body was detected in four cases (20%), including one impacted at the pylorus. Twenty-seven patients had symptoms of dysphagia. An offending obstruction was found in 10 cases (35%), including four further cases of bolus impaction. Gastric or small bowel disease was identified in three cases. Four patients had odynophagia, and pathology was found in two of these cases (50%). Abnormal motility was noted in seven (14%) of these 50 patients.

The emergent contrast esophagram is of value when esophageal pathology is suspected. Perforation is an uncommon occurrence but has a recognized high morbidity and mortality if diagnosis and treatment are delayed. Esophagraphy is able to reliably diagnose or exclude this possibility. If the suspected pathology is not found, consideration should be given to alternative diagnoses, including dysmotility or a downstream lesion.