Timed barium swallow in the assessment of esophageal emptying in patients with achalasia: How to do it and what to look for

Congress:

ECR 2018

Poster Number:

C-1891

Type:

Educational Exhibit

Keywords:

Gastrointestinal tract, Fluoroscopy, Barium meal, Technical aspects, Dynamic swallowing studies, Swallowing disorders, Motility, Eating disorders, Stomach (incl. Oesophagus)

Authors:

M. A. Serrano¹, I. V. Toledo Coronado², D. Butrón Hernández³, E. M. León Guerrero¹; ¹Mexico/MX, ²Cd de México/MX, ³PACHUCA, HGO./MX

DOI:

10.1594/ecr2018/C-1891

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-1891

Fig. 1: Timed barium swallow in the assessment of esophageal emptying in patients with...

Fig. 2: Eckardt Grading System for evaluate clinical symptoms of achalasia.

Fig. 6: Time barium esophagogram technique. The patient is instructed to drink up to...

Fig. 7: Time barium esophagogram. Videofluoroscopy showing the patient ingesting 250 ml...

Fig. 8: Time barium esophagogram in a 29 year old woman with achalasia. Spot film 1,2...

Fig. 11: Interpretation of timed barium esophagogram. Radiographs taken 1, 2 and 5...

Fig. 13: Evaluation of treatment response. Baseline time barium esophagogram at 1 (A), 2...

Learning objectives

The purpose of this exhibit is: To describe the Time Barium Esophagogram (TBE) technique Get acquainted with the proper way to perform the measurements of the height and width of the barium column To learn how to avoid inadequate measurements in difficult scenarios (barium foam interface) To show key points in the interpretation of images for correlation with clinical response to treatment

Background

Introduction: Achalasia is a primary neurological esophageal motor disorder, characterized by the absence of primary peristalsis and incomplete or absent relaxation of lower esophageal sphincter (LES) with swallowing, and normal or abnormal high resistance LES pressure. It is the most common esophageal motor disorder, with mean incidences of 0.3-1.63 per 100 000 people per year in adults, it occurs with equal distribution in men and women with a bimodal distribution, early onset at age 20 to 40, and late onset after age 60. The clinical...

Findings and procedure details

How to interpret data: The esophagus emptying is assessed over time (Fig. 8) with the heights and widths of the barium column. The barium height (Fig. 9a) is the distance from the distal esophagus (identified by the bird´s beak appearance at the level of LES) to the top of the barium column (at the level at which the barium-foam interface is best defined), and barium width (Fig. 9b) is the maximum diameter of the barium column, measured perpendicular to the approximated long axis at its...

Conclusion

Time barium esophagogram evaluates the effectiveness of treatment for achalasia better than does an evaluation of the symptoms themselves. This technique is also simple to do and interpret, and should be used in patients with achalasia and to follow-up those who have been treated.

Personal information

References

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