Abstract
The selection of the contrast agent used during fluoroscopic exams is an important clinical decision. The purpose of this article is to document the usage of a nonionic, water-soluble contrast (iohexol) and barium contrast in adult patients undergoing fluoroscopic exams of the pharynx and/or esophagus and provide clinical indications for the use of each. For 1 year, data were collected on the use of iohexol and barium during fluoroscopic exams. The contrast agent used was selected by the speech language pathologist (SLP) or the radiologist based on the exam’s indications. A total of 1,978 fluoroscopic exams were completed in the 12-month period of documentation. Of these exams, 60.6 % were completed for medical reasons and 39.4 % for surgical reasons. Fifty-five percent of the exams were performed jointly by a SLP and a radiologist and 45 % were performed by a radiologist alone. Aspiration was present in 22 % of the exams, vestibular penetration occurred in 38 %, extraluminal leakage of contrast was observed in 4.6 %, and both aspiration and leakage were seen in 1 % of the exams. In cases with aspiration, iohexol was used alone in 8 %, iohexol and barium were both used in 45 %, and barium was used alone in 47 %. In cases with extraluminal leakage, iohexol was used alone in 58 %, iohexol and barium were both used in 31 %, and barium was used alone in 11 %. No adverse effects were seen with the use of iohexol. When barium was used in cases of aspiration and extraluminal leakage, the amount of aspirated barium was small and the extraluminal barium in the instances of leakage was small. Iohexol is a useful screening contrast agent and can safely provide information, and its use reduces the risk of aspiration and the chance of leakage of large amounts of barium.
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References
Lareau DG, Berta JW. Fatal aspiration of thick barium. Radiology. 1976;120(2):317.
McAlister WH, Segal MJ. Fatal aspirations in infancy during gastrointestinal series. Pediatr Radiol. 1984;14:81–3.
Tamm I, Kortsik C. Severe barium aspiration into the lung: clinical presentation, prognosis and therapy. Int Rev Thorac Dis. 1999;66:81–4.
Tsokos M, Schultz F, Vogel H. Barium aspiration with fatal outcome. Aktuelle Radiol. 1998;8:2001–3.
Volomdaki E, Ergazakis N, Gourtsagianni N. Late changes in barium sulfate aspiration, HRCT features. Eur Radiol. 2003;13:2226–9.
Buecker A, Wein BB, Nuernberg JM, Guenther RW. Esophageal perforation: comparison of use of aqueous and barium-containing contrast media. Radiology. 1997;202:683–6.
Foley MJ, Ghahremani GG, Rogers LF. Reappraisal of contrast media used to detect upper gastrointestinal perforations: comparison of ionic, water-soluble media with barium sulfate. Radiology. 1982;144:231–7.
Ginai AZ, TenKate FJW, TenBerg RGM, Hoornstra J. Experimental evaluation of various available contrast agents for use in the upper gastrointestinal tract in case of a suspected leakage: effects on the mediastinum. Br J Radiol. 1985;59(691):585–92.
Ginai AZ, TenKate FJW, TenBerg RGM, Hoornstra K. Experimental evaluation of various available contrast agents for use in the gastrointestinal tract in case of suspected leakage: effect on lungs. Br J Radiol. 1984;57:895–901.
Phillips LG Jr, Cunningham J. Esophageal perforation. Radiol Clin N Am. 1984;22(3):607–13.
Ginai AZ. Barium sulfate versus water-soluble low osmolar contrast medium in esophageal examinations [Letter to the Editor]. Radiology. 1997;205(1):287–8.
Davenport D, Cohen MD, Hanna M, Bugaieski E, Heifetz SA. Studies of iohexol in the rabbit lung and peritoneum. Pediatr Radiol. 1999;29:724–30.
American College of Radiology Manual on Contrast Media, ver. 8. Reston: American College of Radiology; 2012.
Ginai AZ, Babberman A, Zondervan PE, Van Leeuwen W, Morcos SK. The histologic response of the lungs of rats to potentially suitable water soluble bronchographic contrast agents Iotrolan, a nonionic dimer, and Iopamidol, a nonionic monomer. Br J Radiol. 1993;66:773–7.
Belt T, Cohen MD. Metrizamide evaluation of the esophagus in infants. Am J Roentgenol. 1984;143:367–9.
Cohen M, Smith WL, Smith JA, Gresham EL, Schreiner R, Lemons J. The use of Metrizamide to visual the gastrointestinal tract in children: a preliminary report. Clin Radiol. 1980;31:635–41.
Cohen MD. Choosing contrast media for the evaluation of the gastrointestinal tract of neonates and infants. Radiology. 1987;162:447–56.
Ratcliffe JF. The use of low osmolarity water-soluble contrast media in the pediatric gastrointestinal tract: a report of 115 examinations. Pediatr Radiol. 1986;16:47–52.
Brick SH, Caroline DF, Lev-Toaff AS, Friedman AC, Grumbach K, Radecki PD. Esophageal disruption: evaluation with Iohexol esophagography. Radiology. 1988;1:141–3.
Iohexol package insert. GE Healthcare. 2005. http://www.medlibrary.org/lib/rx/meds/omnipaque/. Accessed July 2007.
Katayama H, Yamaguchi K, Kozuka T, et al. Adverse reactions to ionic and nonionic contrast media. Radiology. 1990;175:621–8.
Keberle M, Wittenberg G, Trasen A, Baumgartner W, Hohn D. Comparison of iodinated and barium-containing contrast media of different viscosity in the detection of pharyngeal perforation. Fortschr Rontg Neuen. 2001;173:691–5.
Swanson JO, Levine MS, Redfern RO, Rubesin SE. Usefulness of high-density barium for detection of leaks after esophagogastrectomy, total gastrectomy and total laryngectomy. Am J Roentgenol. 2003;181:415–20.
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Julie A. Harris declare no conflict of interest.
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Harris, J.A., Bartelt, D., Campion, M. et al. The Use of Low-Osmolar Water-Soluble Contrast in Videofluoroscopic Swallowing Exams. Dysphagia 28, 520–527 (2013). https://doi.org/10.1007/s00455-013-9462-0
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DOI: https://doi.org/10.1007/s00455-013-9462-0