Type:
Educational Exhibit
Keywords:
Swallowing disorders, Obstruction / Occlusion, Motility, Dynamic swallowing studies, Fluoroscopy, Gastrointestinal tract, Contrast agents, Stomach (incl. Oesophagus)
Authors:
L. Royle, S. Patel, N. Griffin; London/UK
DOI:
10.1594/ecr2018/C-0864
Findings and procedure details
Method:
Using the local Computerised Radiology Information System (CRIS),
a search for all contrast swallows across the 6 month period between January to June 2017 was carried out.
Within the clinical information of the study request,
those patients who also had an OGD were identified.
The fluoroscopy report of these patients was then analysed to identify pathology.
The fluoroscopic findings were then correlated to OGD findings.
Resources:
iCRIS,
Sectra PACS.
Results:
n= 90
Excluded: 2 patients had incomplete OGDs,
7 had naso-endoscopy only.
Final number of patients included in this study: n=81
Finding: |
Number of Studies |
% of Studies (%) |
OGD & contrast swallow correlate |
35 |
43.2 |
Additional findings on contrast swallow |
10 |
12.3 |
OGD & contrast swallow do not correlate |
36
(of note: 22 had a normal OGD) |
44.4 |
Total |
81 |
|
The following results are separated by pathology rather than by patient.
Of note there may be more than one finding on OGD which may or may not correlate to one or more finding on contrast swallow.
Findings on OGD and contrast swallow are as shown in the below table.
Pathology
|
OGD &
contrast swallow
|
OGD only
|
Contrast swallow only
|
None/normal
|
19
|
22
|
13
|
Hiatus hernia
|
12
|
10
|
5
|
Stricture
|
2
|
0
|
0
|
GIST
|
1
|
0
|
0
|
Dysmotility
|
1
|
tortuous
oesophagus: 1
|
27
|
Web
|
0
|
0
|
5
|
Achalasia
|
0
|
0
|
1
|
Pouch
|
0
|
0
|
2
|
Reflux
|
1
|
signs of reflux: 5
|
0
|
Candida
|
0
|
2
|
0
|
Inlet patch/polyp
/nodule/diverticulum
|
0
|
4
|
0
|
Fig. 1: Lateral swallow demonstrating pharyngeal web where an OGD was normal.
Fig. 2: Anterior-Posterior (AP) projection of the above patient; a lucent horizontal line denotes the pharyngeal web.
Fig. 3: Prone positioning demonstrates a hiatus hernia that was not detected on OGD.
Fig. 4: Tertiary oesophageal contractions on erect swallow. Subtle cases of dysmotility can be elicited with prone swallow.
Fig. 5: Normal OGD, swallow study indicates small pharyngeal web (not depicted here) and a small posterior pouch.
Fig. 6: AP projection demonstrating a small pouch retaining contrast in the same patient as above.
Fig. 7: OGD was normal, swallow demonstrates tapering of the gastro-oesophageal junction and dilatation of the distal oesophagus in keeping with achalasia.
Fig. 8: OGD demonstrated reflux oesophagitis, swallow study confirms the presence of reflux and associated sliding hiatus hernia.