Topic Barium swallow For better understanding of anatomy, Indications, contraindications, contrast , techniques, complications....

1. Barium Swallow

2. ● Anatomy
● Indications
● Relative Contraindications
● Contrast
● Technique
● Specific Conditions
● Complication

3. Anatomy
1.Oral cavity
● Nasopharynx
● Oropharynx
● Larynx
2. Esophagus
● Upper esophagus spincter
● Lower esophagus spincter

4. 3.Stomach
● Fundus
● Cardia
● Body
● Antrum
● Pyloric

5. DEFINITION :-
Barium swallow is the contrast study from oral
cavity upto the fundus of the stomach.

6. Indication
1. Dysphagia and obstruction.
2. Pain during swallowing.
3. Assessment of mediastinal masses.
4. Assessment of left atrial enlargement.
5. Pre-op assessment of carcinoma bronchus and oesophagus.
6. Motility disorders of oesophagus, E.g.: Achalasia and diffuse
oesophageal spasm, scleroderma.
7. Assessment of site of perforation.
8. Zenker's diverticulum and cricoid webs. In these cases water
soluble contrast media are used.
E.g. : Gastrograffin or dionosil aqueous.

7. Mediastinal mass Dysphagia

8. Achalasia. Scleroderma. Diffuse esophageal spasm
Mortality Disorders

9. Z
Zenker’s Diverticulum. Cricoid webs

10. RELATIVE CONTRAINDICATIONS
• Tracheo oesophageal fistula.
• Perforation.

11. CONTRAST
• 100% Barium sulphate paste.
• 80% Barium sulphate suspension.
• 30% Barium sulphate suspension for high kV technique.
• 200-250% high density, low viscosity for double contrast study

12. TECHNIQUE
Pharynx
1.One 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.
2.To get optimum distension of the pharynx, exposure is triggered at the time
when the hyoid bone is at the highest point during swallowing.

13. To Get Optimum Mucosal Coating
1.One mouthful of contrast media (Barium sulphate paste) is given to
the patient and the patient is instructed to swallow once and stop
swallowing there after.
2.Spot films are taken in frontal and lateral
projections (better way is to ask patient to keep mouth open or
say eee .... eee .... after one swallow) or patient performs valsalva
maneuver in erect position with nose closed. Frontal and lateral spots
are taken to show distended pyriform sinuses and valecullae.

14. Oesophagus
Single Contrast
1.Multiple mouthfuls of 80% w /v Barium suspension are given.
2.Follow the barium bolus down the oesophagus and observe the peristalsis
always in supine position.
3.Films are exposed in erect positionRAO, LAO, frontal and lateral views when
the oesophagus is well distended.
4. In RAO position esophagus is projected clear
of the spine.
5.The escape of contrast at the level of the diaphragmatic hiatus
should not be confused for reflux.
6.Mucosal film is taken in RAO after the oesophagus is empty.
7.Then the fundus of the stomach, & G-0 junction are assessed with
spot films in different obliquities in erect and recumbent positions

15. Double Contrast
1.Barium contrast should be high density, low viscosity (200 to 250%).
15-20 ml Barium is given in the mouth and the patient is asked to
swallow.
2.Then effervescent powder is given with another mouthful of barium.
3.In erect position, gas tends to stay up, resulting in adequate
distension which stays for longer time as compared to supine position.
Prone position also retains more gas within the oesophagus and gives
adequate distension.
4.Hypotonia using Buscopan or Glucagon keeps the esophagus
distended for a longer time (Inj. Buscopan 2ml LV. given just before
the procedure).
5.Filming is done in frontal, lateral, RAO and LAO.

16. Mucosal relief view. . Single contrast view's . Double contrast view's .

17. SPECIFIC CONDITIONS
1. Severe dysphagia for both solids and liquids: A little dilute
Barium is given initially-5ml. Further filming and contrast
depends on the abnormality observed.
2. Pharyngeal Web: Video fluorography in frontal and lateral
projection is the best technique for investigating disorders of
swallowing. 50/50 dilution of standard high density barium will
show webs more readily. Films in supine for frontal, and erect for
lateral views are taken at maximum distension of the pharynx.
3. Foreign body impaction: To detect the level of obstruction in case
of radio-lucent foreign body in the oesophagus, a marsh mallow
coated with barium is swallowed whole. The passage of marsh
mallow will be hindered at the level of obstruction. Similarly,
cotton soaked with barium can be swallowed, but advantage of
the marsh mallow is that it dissolves spontaneously

18. 4. In Carcinoma: High viscosity, normal density liquid barium is given.
5. Motility disorders: A minimum of 5 mouthfuls of contrast should
be given to study the motility disorders of the oesophagus, out of
which more than 2 mouthfuls should be abnormal for a positive
diagnosis. For motility disorders, a prone swallow is essential to
assess oesophageal contraction in the absence of gravity.
Disorders are either of peristalsis or sphincter abnormalities
(lower and upper oesophageal sphincters).
6. Achalasia: The oesophagus should be cleansed thoroughly (aspirate
and wash) so that secondary achlasia due to Ca oesophagus may
not be missed. Barium 80% w /v is used and the patient should
be studied in erect position. To differentiate achalasia from other
conditions showing abnormal peris-talsis, mecholyl test is done.
On administration of mecholyl, there will be hyperperistalsis,
pain and streaks of contrast entering the stomach confirming the
diagnosis of achalasia.

19. 7. Tracheo Oesophageal fistula
• Congenital
• Acquired
Ideal contrast is non-ionic water soluble contrast media.
When barium is used it should be fluid-like and patient should
be lying lateral. Do not forget to put the patient prone if a fistula
is not identifiable in the lateral position. If the fistula is seen, stop
the procedure, since barium aspiration may result in inflammation
and granuloma formation in the lung.
8. Hiatus hernia: High abdominal pressure is required to demonstrate
hiatus hernia. For this
• Patient has to strain.
• Patient is asked to lie down, straighten the legs and then raise
them up.
• Manual compression of the abdomen.
• Patient stands upright, ask him to bend downwards with legs
straight.

20. 9.Gastro oesophageal reflux: Siphon test.
Fill the stomach with 50%Barium (150-200 ml).
Follow this with 1-2 mouthfuls of water to remove traces of barium in the
oesophagus.Make the patient supine with left side raised 15° up.
Keep one mouthful of waterbin the patients mouth.
Ask the patient to swallow the water-a jet of barium will shoot into the water
column as it enters thenG.O. junction.
Alternatively with full stomach, ask the patient to
roll from side to side on the table. Reflux will be seen.
To promote reflux, abdominal pressure can be raised by straight
leg raising or putting patient prone with the bolster under the
abdomen at the level of the umbilicus, but these are unphysiological.
10.Oesophageal Varices : Supine right side up position, high density
thin barium should be used. Varices are best demonstrated in
mucosa! relief study after using Buscopan and valsalva maneuver

22. COMPLICATION
1. Leakage of barium from an unsuspected perforation-granuloma
formation.
2. Aspiration.

23. Thank you