BARIUM
SWALLOW
PRESENTED BY
A. FATHIMA SAFA ✨
INTRODUCTION
• BARIUM SWALLOW IS THE
CONTRAST STUDY FROM ORAL
CAVITY UPTO THE FUNDUS OF THE
STOMACH
• A BARIUM SWALLOW IS A TEST USED TO DETERMINE THE CAUSE
OF
PAINFUL SWALLOWING, DIFFICULTY WITH SWALLOWING,
ABDOMINAL PAIN OR UNEXPLAINED WEIGHT LOSS.
ANATOMY
THE ALIMENTARY CANEL IS ABOUT 9 METERS IN LENGTH
• IT COMPRISES OF THE FOLLOWING PARTS
• THEY ARE
1. MOUTH
2. PHARYNX
3. OESOPHAGUS
4. STOMACH
5. SMALL INTESTINE
6. LARGE INTESTINE
7. RECTUM
8. ANAL CANAL
• UPPER ALIMENTARY TRACT COMPRISES OF ORAL CAVITY , OESOPHAGUS,
STOMACH, AND
SMALL INTESTINE
• PHARYNX
THE PHARYNX IS A TUBE THAT CONNECTS THE MOUTH TO BOTH THE LARYNX
AND THE OESOPHAGUS. IT IS ABOUT 14 TO 15 CM IN LENGTH
• OESOPHAGUS
THE OESOPHAGUS IS A NARROW MUSCULAR TUBE. IT IS ABOUT 25 CM LONG
IT IS A FOOD PASSAGE WAY BETWEEN THE PHARYNX AND THE STOMACH.
IT EXTENDS FROM THE LOWER END OF THE PHARYNX TO THE CARDIAC END
OF THE STOMACH
BOTH THE END OF THE OESOPHAGUS IS CLOSED BY SPHINCTER MUSCLES
OESOPHAGUS
• STOMACH
STOMACH IS THE MOST DILATED PORTION OF THE ALIMENENTARY TRACT
IT IS LOCATED IN THE LEFT UPPER PART OF THE ABDOMINAL CAVITY
THE UPPER PART OF THE STOMACH IS A CONTINUATION OF THE OESOPHAGUS
AND THE LOWER PART IS CONTINUOUS WITH THE DUODENUM
THE STOMACH IS DIVIDED INTO CARDIAC, FUNDUS OF THE STOMACH, BODY
OF THE STOMACH, AND THE PYLORIC PART
INDICATION
• DYSPHAGIA
• OBSTRUCTION
• ACHALASIA CARDIA
• STRICTURE FORMATION
• ESOPHAGEAL CARCINOMA
• PAIN DURING SWALLOWING
CONTRA INDICATION
• TRACHEO ESOPHAGEAL FISTULA
• PERFORATION
• PREGNANCY
EQUIPMENT
• FLUOROSCOPY UNIT WITH SPOT FILM DEVICE
• CONTRAST MEDIA
• FEEDING CUP
• DISTILLED WATER
CONTRAST MEDIA
• POSITIVE CONTRAST
• HIGHLY RADIOPAQUE
• INSOLUBLE IN WATER
• NON TOXIC
• ABSORBS MORE X RAYS
• BASO4
• ATOMIC NUMBER 56
• CAN BE USED FOR DOUBLE CONTRAST STUDIES
• 100% BARIUM SULPHATE PASTE.
• 80% BARIUM SULPHATE SUSPEN-SION.
• 30% BARIUM SULPHATE SUSPENSION FOR HIGH KV
TECHNIQUE.
• 200-250% HIGH DENSITY, LOW VISCOSITY FOR
DOUBLE CONTRAST STUDY.
PATIENT PREPARATION
• ENSURED THAT NO CONTRAINDICATION TO THE
PHARMACOLOGICAL AGENT USED.
• CHECK PREGNANCY STATE.
• PROCEDURE SHOULD BE EXPLAINED TO PATIENT BEFORE
UNDERGOING THE PROCEDURE .
• NIL ORALLY FROM 3HOURS PRIOR TO THE PROCEDURE.
• REMOVE ALL METALS FROM THE REGION OF INTEREST.
• TECHNIQUE
PHARYNX
• 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.
• TO GET OPTIMUM DISTENSION OF THE PHARYNX,
EXPOSURE IS TRIGGERED AT THE TIME WHEN THE
HYOID BONE IS AT THE HIGHEST POINT DURING
SWALLOWING.
TO GET OPTIMUM MUCOSAL COATING
• 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.
• SPOT FILMS ARE TAKEN IN FRONTAL AND LATERAL
PROJECTIONS
SINGLE CONTRAST
• MULTIPLE MOUTHFULS OF 80% W/V BARIUM SUSPENSION ARE
GIVEN.
• FOLLOW THE BARIUM BOLUS DOWN THE OESOPHAGUS AND
OBSERVE THE PERISTALSIS ALWAYS IN SUPINE POSITION.
• FILMS ARE EXPOSED IN ERECT POSITIONRAO, LAO, FRONTAL AND
LATERAL VIEWS WHEN THE OESOPHAGUS IS WELL DISTENDED.
• IN RAO POSITION ESOPHAGUS IS PROJECTED CLEAR OF THE SPINE.
• LATERAL FILM IS TAKEN IN ERECT AND FRONTAL FILM IN SUPINE
POSITION.
DOUBLE CONTRAST
• 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.
• THEN EFFERVESCENT POWDER IS GIVEN WITH ANOTHER
MOUTHFUL OF BARIUM. 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
• HYPOTONIA USING BUSCOPAN OR GLUCAGON KEEPS THE
ESOPHAGUS DISTENDED FOR A LONGER TIME (INJ. BUSCOPAN 2ML
IV
• GIVEN JUST BEFORE THE PROCEDURE). FILMING IS DONE IN
FRONTAL, LATERAL, RAO AND LAO.
• INTRODUCTION OF GAS FOR DOUBLE CONTRAST STUDIES CAN ALSO
BE DONE THROUGH A TUBE PASSED INTO THE UPPER OESOPHAGUS.
NORMAL AP / LAT VIEW
RAO
• EASOPHAGUS IS SEEN BETWEEN THE HEART
AND THE SPINE
• THE PATIENT IS ROTATED 35-40 DEGREE
WITH THE RIGHT SIDE AGAINST THE TABLE
FOREIGN BODY
ACHALASIA
• FINDINGS OF ACHALASIA ON BARIUM SWALLOW
INCLUDE
A PERSISTENTLY NARROWED REGION AT THE END
OF THE
ESOPHAGUS WITH THE DILATED ESOPHAGUS
ABOVE THE
NARROWED REGION
ESOPHAGEAL CARCINOMA
• USUALLY INVOLVES UPPER OR MID ESOPHAGUS
ESOPHAGEAL STRICTURE
• STRICTURE FORMATION DUE TO INFLAMMATION,
FIBROSIS (THICKENING OF TISSUE)
COMPLICATIONS
• LEAKAGE OF BARIUM FROM
UNEXPECTED PERFORATION
• ASPIRATION
AFTER CARE
• EAT AND DRINK AS NORMAL BUT WITH EXTRA FLUID
• PATIENTS IS WARNED ABOUT STOOL WITH WHITE FOR SOME
DAYS
CONCLUSION
• BARIUM SWALLOW IS A SAFE AND EASY INITIAL TEST FOR
UPPER GI COMPLAINTS.
REFERENCES
